Tenet Healthcare Charge Review Specialist II (RISII) in Bremerton, Washington
As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
This job is responsible for ensuring that all appropriate billing charges for complex service lines are being captured, documented, charged and reimbursed for the assigned department in accordance with policies and procedures, and applicable regulatory standards and requirements. Position requires a working knowledge of CPT codes. Focuses on work unit and/or service-line reconciliation processes.
ESSENTIAL DUTIES ANDRESPONSIBILITIES
Include thefollowing. Others may be assigned.
Ensures accurate and timelycharge-capture methodologies are in place and followed for the assigned workunit or service line, and that they are consistent (in terms ofstandardization) across pertinent areas/facilities as appropriate; reconcilescharges against source documents to ensure that charges have been capturedcompletely and accurately; monitors compliance with internal standards andprocedures, and reports non-compliance issues to proper authority.
Identifies billing errors and/oromissions, working with appropriate staff/team members; ensures thatrevisions/corrections forwarded and incorporated in processing systems intimely manner.In-depth research andanalysis may be required. Strong working knowledge of CPT codes are essential.
Provides training to staff engaged inbilling data entry and related charge-capture/reconciliation activities toensure procedures are understood and that charges booked are timely,appropriate, accurate, complete and properly documented.
Prepares reports, and provides departmentalsummary information to the Revenue Cycle team which is responsible for ensuringthat all charges on a system-wide basis are being captured, charged andreimbursed appropriately and for overall compliance.
Maintain proficiency in potentially includingsubject matter including injection & infusion CPT Coding/charging,Observation, & abstracting of inpatient record to identify proceduresperformed.
Provide subject matter expertise toimplement changes & system improvements that prevent charging errors andomissions as wells as collaborating in the upkeep & maintenance of clinicalcharging systems.
Other Duties as assigned includingedit/holds, coordination with CDM team/system, client & peer education
To perform this jobsuccessfully, an individual must be able to perform each essential dutysatisfactorily. The requirements listed below are representative of theknowledge, skill and/or ability required. Reasonable accommodations may be madeto enable individuals with disabilities to perform the essential functions.
Knowledge of the accepted principles,practices and tools relating to general healthcare billing, cost accounting andreimbursement.
Knowledge of policies, standards andmethodologies pertaining to charge capture and reconciliation, reporting,documentation and general compliance.
Knowledge of the content and applicationof published health information management coding conventions, e.g., asreferenced in "Coding Clinics" and/or other nationally recognized codingguidelines.
Ability to recognize, research, andcorrect charging/documentation discrepancies.
Knowledge of the standards andregulatory requirements applicable to matters within designated scope ofauthority, including medical/legal issues.
Working knowledge of medical terminologyand abbreviations, and health care nomenclature and systems.
Ability to use office equipment andautomated systems/applications/software at an acceptable level of proficiency.
Ability to establish and maintaineffective working relationships as required by the duties of the position.
Include minimumeducation, technical training, and/or experience preferred to perform the job.
At least 3 years recent directly relatedwork experience in a healthcare environment with significant exposure tohealthcare charging/coding or completion of a recognized course of study forhealth information practitioners or coding specialists and one year codingexperience in an acute hospital health information management department
Proficient in CPT/HCPCS code assignmentincluding Evaluation & Management facility coding guidelines
High School graduate or equivalentrequired
College degree preferred.
The physical demandsdescribed here are representative of those that must be met by an employee tosuccessfully perform the essential functions of this job. Reasonableaccommodations may be made to enable individuals with disabilities to performthe essential functions.
Must be able to work in sitting position,use computer and answer telephone
Ability to travel
Includes ability to walk throughhospital-based departments across broad campus settings, including EmergencyDepartment environments
The work environmentcharacteristics described here are representative of those an employeeencounters while performing the essential functions of this job. Reasonableaccommodations may be made to enable individuals with disabilities to performthe essential functions.
Office Work Environment
Hospital Work Environment
Job: Conifer Health Solutions
Title: Charge Review Specialist II (RISII)
Requisition ID: 2005038656