HIM Specialist Part Time

Jupiter Medical Center

Ranked #1 for Safety, Quality and Patient Satisfaction, Jupiter Medical Center is the leading destination for world-class health care in Palm Beach County and the greater Treasure Coast.

Outstanding physicians, state-of-the-art facilities, innovative techniques and a commitment to serving the community enables Jupiter Medical Center to meet a broad range of patient needs. Jupiter Medical Center is the only hospital in Palm Beach, Martin, St. Lucie and Indian River counties to receive a 4-star quality and safety rating from the Centers for Medicare & Medicaid Services (CMS).

Education

• Associate or bachelor's degree, 2 plus years' experience working acute care healthcare

Experience / Qualifications

• 2 plus years in Hospital Revenue Cycle experience
• Knowledge of Government and Third-Party payor Regulations and Standards
• Familiar with ICD10, CPT, HCPCS, revenue center and other billing requirements
• Knowledge of ADRs, post payment audits and appeals processes, requirements and guidelines
• Understand basic medical record documentation and EHR processing
• Must be familiar with medical terminology, coding processes, clinical documentation and government and non-government reimbursement methodologies
• Must be detail oriented, multi-task and be able to meet deadlines
• Good computer skills with proficiency in windows, PDF tools and excel application, analytic and be able to create reports
• Ability to present data to small groups

Position Summary

The HIM Appeals Specialist is responsible to assist department leadership in monitoring daily ADR, RAC and other Third-party request.

Responsibilities include:

• Research each request to determine reason for record request and type of records necessary to support potential denial
• Identify any potential opportunities for trends in documentation discrepancies, charging, coding or billing
• Coordination of record processing, and sequencing records per the record request
• Serves as a liaison between departments to request additional information, including physician practices
• Research and investigate NCD/LCD for medical necessity, documentation requirements, units and other required coding/billing requirements and billing payors
• Develops and prepares data/reports for monthly meetings and provides input on process improvement
• Develops tools for departments to prevent future ADR/denials
• Researches governmental and non-governmental payor regulations and policies and update key stakeholders
• Report pending delays in processing request/follow up cases with Director HIM and adds notes to system for tracking purposes
• Keeps Director and other key stakeholders on potential negative financial impact
• All other duties assigned

Team Member Competencies

Establishing Relationships

Builds effective networks, working relationships, and alliances in order to collaborate effectively within department and organization. Can relate to all kinds of people regardless of background; find topics and common interests that can be used to build rapport with others.

Peer Support

Provides guidance and feedback to help others strengthen knowledge/skills needed to accomplish tasks, solve problems, and perform effectively within the team.

Inspiring and Motivating Others

Fosters commitment and cohesiveness by facilitating cooperation and working as a team within the organization toward goal accomplishments. Work well with others, build consensus, and ensure cooperation to complete tasks and positive workflow.

Demonstrating Emotional Intelligence

Exercises self-leadership, self-awareness, and self-regulation; manages emotions so that they are expressed appropriately; leads others by showcasing adaptability, empathy, and social skills.

Acting with Integrity

Interacts with others in a way that is seen as direct and truthful; ensures confidence in individual and organizational motives and representations. Acts in a way that is consistent with personal and organizational values by keeping confidence, promises, and commitments. Clearly states goals and beliefs; informs people of their true intentions, does what they say they will do; follows through on commitments.

Being a Champion for Change and Innovation

Supports people in their efforts to try new things. Things creatively, generates novel and valuable ideas and uses these ideas to develop new or improved processes. Accepts new ways of doing things and adapts to change.

Communicating Effectively

Speaks and writes clearly, conveys information in a concise, organized, and logical manner. Is adept at tailoring the message to fit the interests and needs of the audience. Listens attentively and exercises tact, discretion, and diplomacy when interacting with members of the department and organization.

Promoting Diversity and Inclusion

Treats all people with dignity and respect. Demonstrates an open-minded approach to understanding people regardless of their gender, age, race, national origin, religion, ethnicity, disability status, or other characteristics. Challenges bias and intolerance. Develops all-inclusive groups in the realms of social interaction and communication. Shows respect for the beliefs of others; encourages and promotes practices that support cultural diversity; discourages behaviors or practices that may be perceived as unfair, biased, or critical toward people with certain backgrounds.

Physical Requirements

Requires sitting for long periods of time, also stooping, bending, standing, and stretching. Must have manual dexterity for typing and computer data entry. Able to work under a stressful environment, work independently, capable of making sound decisions, be detail oriented, alert, and self-motivated. Ability to push/pull up to 40lbs., carry and lift up to 20lbs.

Threshold Requirements

• These threshold requirements are required and completed yearly basis
  • Annual Joint Commission mandatory education requirements, in-service and health requirements including attendance at new employee orientation
  • TB/PPD Surveillance Program
  • Maintenance of required professional licensing and/or certification(s)

This is not necessarily an extensive list of all responsibilities, skills, duties, requirements, or working conditions associates with the job. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or require that other or different tasks be performed when circumstances change. I have reviewed these job requirements and verify that I can perform all essential functions of this position