Claims Edit Specialist-PRN - Hopkinsville, United States - Jennie Stuart Medical Center

Description

Under the direction of the Coding/CDI Manager and Director of Health Information Management Department and according to established JSH policies and procedures the HIM Charge Specialist is responsible for reviewing medical record documentation to determine appropriate facility charge codes to include E/M, infusion and injection administration and procedure charges, and accurately enter these charges in an efficient and timely manner.

Functional Demands
Reports to Coding/CDI Manager and/or HIM Director
Organizational Expectations
Provides a positive and professional representation of the organization.
Promotes culture of safety for patients and employees through proper identification, reporting, documentation, and prevention.
Maintains hospital standards for a clean and quiet patient environment to maintain a positive patient care experience.

Maintains competency and knowledge of current standards of practice, trends, and developments in related scope of job role or practice.

Adheres to infection-control policies and protocols, medication administration and storage procedures, and controlled substance regulations.
Participates in ongoing quality improvement activities.

Maintains compliance with organization's policies, as well as established practices, protocols, and procedures of the position, department, and applicable professional standards.

Complies with organizational and regulatory policies for handling confidential patient information.

Demonstrates excellent customer service through his/her attitude and actions, consistent with the standards contained in the Vision, Mission, and Values of the organization.

Adheres to professional standards, hospital policies and procedures, federal, state, and local requirements, and TJC standards and/or standards from other accrediting bodies.

As a Studer Partner must have the ability to develop a full understanding of the Studer Group practices and tools and communicate effectively.

Must embrace the Studer Philosophy and Principals by conducting him/herself in a professional manner.

Will be held accountable to the following Studer Philosophies and Principles:

Hourly Rounding with intention
Bedside Shift Report

AIDET
Daily Huddles
Essential Functions
Proficiency in applying appropriate charge codes to Emergency Room, Admissions, and Observation accounts, ensuring all charges are captured.
Effectively communicates with other departments to request information, as well as to review issues, concerns effecting reimbursement.
Maintains up-to-date knowledge of governmental and managed care policies and procedures. Demonstrates ability to interpret and communicate regulations to ensure compliance.
Makes recommendations to management, actively participates in continuous quality improvement and enhances reimbursement.
Understand utilization of modifiers and other coding rules to include: Coding Clinic, AMA, as well as payer specific guidelines.
Knowledge of medical terminology and consistent application of medical documentation requirements.
Requires advanced knowledge of ICD-10-CM; ICD-10-PCS; CPT-4; and HCPCS coding systems.
Experience in assigning Evaluation and Management, injection and infusion administration codes.
Ability to prioritize workload to meet established timelines
Attention to detail in entering data accurately
Experience in 3M Coding/Reimbursement System
Proficiency in following established coding policies and procedures
Excellent organizational skills
Ability to effectively collaborate remotely with management, HIM staff, medical staff, Business Office.
Proficient in Microsoft Excel and Word.
Assist with charge entry in all areas as needed.
Non-Essential Functions/ Marginal Duties
Other duties as assigned
Required Skills

Licensure/Certification/Education:
Requires advanced knowledge of charge functions, ICD-10-CM, CPT-4, and HCPCS coding systems


Required Licenses:
CCS, CCS-P or CPC. RHIT preferred.
Associate or Bachelor's Degree in health care or business equivalent is preferred.
Required Experience
Two (2) years of experience in facility-based coding.

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