REIMBURSEMENT SPECIALIST

Reimbursement Specialist

The Reimbursement Specialist position is in our Clinical Charge Capture Team within the Revenue Management Department. On this team the Reimbursement Specialist is responsible for accurate and timely manual charge posting for our three hospitals and various outpatient areas. The Reimbursement Specialist posts charges for drug administration/infusion according to coding guidelines, review and update observation hours and carve-outs according to current CMS guidelines, ER levels and procedures on admitted ER visits for five emergency rooms (to either observation or inpatient), several HOPD (hospital outpatient physician departments) offices, and other ancillary departments. The Reimbursement Specialist is responsible for obtaining optimal revenue while maintaining compliance with all regulations. Reimbursement Specialist will also include the review of all outpatient observation and inpatient encounters for accurate admission status. The Reimbursement Specialist is required to have knowledge of; charge capture and flow processes, charging information systems, coding and reimbursement regulations. May also be expected to assist in performing other administrative tasks assigned as well as assisting other areas of the revenue cycle division or clinical services division as deemed necessary.

Department Summary

Responsible for maintaining and monitoring charges for three hospitals and all outpatient departments, following governmental regulatory guidelines. This department also assists HIM and ROI with system functions and implementations. As an integral part of the revenue cycle division, we are a go-to department for reporting and data mining in both multiple revenue cycle systems and EMR. Our department collaborates closely with IT, clinical staff and finance.

Qualifications

High School Diploma or equivalent. Minimum of two years billing or coding experience in a hospital or physician office setting. Solid computer skills (Health Quest Medipac, Cerner, Microsoft TEAMS, Excel, Word, Power Point). Experience in hospital reimbursement, revenue audits or charge capture. Knowledge of current Medicare and other regulatory billing guidelines. Ability to manage multiple demands from a variety of constituents. Health information or nursing professional helpful. CCS, CCSP or Coding Certificate helpful.

Skills

Good time management skills. Critical Thinker. Detail oriented. Effective Communicator. Ability to work in a productivity driven workflow. Comfortable speaking to large groups and presenting. Ability to work independently or in a team environment.

Responsibilities

Expectations include reviewing all clinical documentation daily for observation and inpatients for correct admission status, identifying and correcting all registration errors regarding account status, reviewing all discharged observation and inpatient encounter documentation to charge drug administration/infusion charges according to coding guidelines, completing facility charge ticket on all ER admits for level charges and batch charge enter any procedures performed in our five ER locations. Manual charge posting for ancillary departments that come via charge sheets. Post facility charges for the HOPD offices. Review charges on AI BOT list that need manually posted. Review documentation on labor and delivery triage patients and post charges according to documentation. Review and accurate charging for pulmonary physicians group on OBV and inpatient encounters. Assist manager with communication regarding clinical documentation in relation to charge capture. Understand and maintain a current knowledge of all regulations regarding observation billing and reimbursement. Daily tracking of all chart type counts. Training of new colleagues and cross training when needed. Maintain productivity and quality standards. Accept change as needed to meet departmental goals. Prepare or assist with other projects/duties assigned.

Working Conditions

Work eight hours a day Monday-Friday. Flex time available. May require occasional additional hours or paid overtime to handle peak volumes which may be outside the normal business hours of operation for the department. Overtime only as needed. At home-based work environment with flexibility after onsite training and competency established. Some travel to various Aultman locations for meetings and projects. Training on site when needed. Hazardous Exposure Category Category III - Includes tasks that involve no exposure to blood, body fluids, or tissues and Category I tasks are not a condition of employment. The normal work routine involves no exposure to blood; body fluids or tissues (although situations can be imagined or hypothesized under which anyone anywhere might encounter potential exposure to body fluids.) Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency care or first aid or to be potentially exposed in some other way.

Physical Addendum Demands

Lifting 0-10 lbs Occasional 10-33% # Lifting 10-20 lbs Never # Lifting 20-35 lbs Never # Lifting 35-50 lbs Never # Lifting 50-75 lbs Never # Lifting 75-100 lbs Never # Lifting over 100 lbs Never # Forward Reaching Never # Overhead Reaching Never # Standing Never # Walking Never For onsite meetings Sitting Continuous 66% of the day # Climbing Never # Stairs/Ladder Never # Bending/Stooping Never # Twisting/Turning Never # Kneeling/Squatting Never # Crawling Never # Pushing/Pulling 0-10 lbs Never # Pushing/Pulling 10-20 lbs Never # Pushing/Pulling 20-35 lbs Never # Pushing/Pulling 35-50 lbs Never # Pushing/Pulling 50-100 lbs Never # Pushing/Pulling over 100 lbs Never # Carrying 0-10 lbs Occasional 10-33% # Carrying 10-20 lbs Never # Carrying 20-35 lbs Never # Carrying 35-50 lbs Never # Carrying 50-100 lbs Never # Carrying over 100 lbs Never # Grasping/repetitive sustained Frequent 34-65% # Fine motor coordination Frequent 34-65% # Vision: Near/Far/Color Frequent 34-65% # Hearing: ordinary conversation/other Continuous 66% of the day # # All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender identity, sexual orientation or protected veteran status. The organization is an EEO/AA Employer M/F/Disability/Vet. # The organization will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on the organization or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the Aultman Human Resource Department and request such an accommodation.