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HI, Release Info. SpecialistJob ID 18396 Omaha, Nebraska
Business: Boys Town National Research Hospital
Under direction of the Manager of Coding and CDI, the HRI Release Info Specialist performs duties of significant difficulty, including the supervision of all professional coding as well as data and charge entry functions. Responsible for finding resolution of non-standard coding issues and assisting in identifying necessary updates or revisions to optimize revenue generation and maximizing reimbursement. Offers expertise and guidance related to claim transactions, coding, auditing, reconciliation, compliance and decision support, as necessary or assigned. Provide education to departments and staff to ensure accurate coding, billing and to improve documentation to support all aspects of coding and billing. Recommends changes in procedures to affect savings in time, labor and costs to improve operating efficiency and the overall good health of the BTNRH revenue cycle. All information coded and processed is used to produce patient bills, statistical reports, and disease and operation indexes, which are required for accreditation, patient and hospital planning, reimbursement by third party carriers, performance improvement and research purposes
Schedule: Full time
- Serves as the primary point person for coding, data entry, and reconciliation of EMR generated for interfaced and manually entered professional charges, per Pt Financial Svcs protocol and procedures, providing coding education as pertinent within the PFS and to appropriate clinical staff
- Oversees the interviewing, selection and evaluation of performance of charge entry, and professional coding personnel
- Ensures proper supervision of daily activities of all personnel in the above functions, providing coaching, mentoring, and discipline as necessary, for optimal performance and an overall healthy revenue cycle.
- Review’s provider documentation (i.e., EMR, operative notes, etc.) coding submissions performed by the Medical Coding Group, including and resulting professional coding and billing from various departments and specialties within BTNRH, per the standards set forth in the Boys Town National Research Hospital (BTNRH) Coding Compliance Plan, reporting on the accuracy of procedure coding, E&M coding, ICD-10 coding and billing, to ensure legal regulations and procedural policies are being followed
- Serves as additional resource to physician and clinical team members for ongoing educational needs related to coding by identifying inaccurate or under-utilized coding and/or billing services; preparing reports of findings, and meeting with providers, medical office staff or leadership to provide education and training on accurate coding practices
- Responsible for monitoring statistical data based on review findings and concurrent reviews for trending purposes and compiling useful summaries for Administration
- Offers assistance as needed to certified coding team to ensure timeliness and accurate charge submission throughout the organization by applying knowledge of ICD-10-CM, inpatient and outpatient coding guidelines and CPT format, guidelines
- Tracks, trends and analyzes coding workflows and work, implementing changes when appropriate to fix issues, or offer more efficiency. This includes using system and workflow updates, education of staff and work with clinical teams and management to achieve set KPI and other metric goals within Pt Financial Svcs, focusing on effectiveness, efficiency, maximizing revenues and reimbursement
- Develops, revises, and implements policies and procedures for the charge entry and professional coding functions, ensuring proper training of new personnel on appropriate PFS operations, software and procedural changes
- Serves as the group’s liaison and is the primary point of escalation with others in the PFS as well as an active resource to coding staff, physicians, clinicians, nurses, clinic staff, and business office in order to maintain observance of approved coding and reimbursement guidelines, Medicare and commercial carrier guidelines and in effort to obtain maximum reimbursement by identifying and offering ongoing educational needs related to coding and documentation optimization. Also works to resolve non-standard surgery verification and coding issues with the business office staff, clinic staff, third party payers, and patients.
- Performs charge reviews as requested through the patient concerns/dispute process by comparing the charges against all necessary clinical documentation, looking for discrepancies and communication findings to the appropriate leaders
- Implements and monitors internal Business Office productivity measures and controls using system reports, staff quality audits or other pertinent information, to ensure coding and charge entry staff’s work is efficient and accurate, ultimately ensuring all PFS key performance indicators are consistently maintained
- Monitors the integrity of the computer directory for diagnosis and procedure codes. Coordinating new service review when necessary as it pertains to finding appropriate new codes and assigning new pricing, per the BTNRH methodology
- Provides back-up to the Hospital Coding team as needed to meet all coding group KPI’s and metrics.
- Other Duties: This job description incorporates the essential functions and duties required for this position. However, other duties may be required and assigned at times and as determined by a supervisor in order to meet the needs of the organization
- Knowledge, Skills and Abilities Required
- In depth knowledge of healthcare coding and billing practices, while serving as the subject matter expert, in professional coding
- Ability to safeguard the privacy of the medical information in the patient record, maintaining strict confidentiality of the patient’s medical and financial records
- Ability to function easily, with a high level of proficiency, in a variety of hospital and clinic patient billing systems and revenue cycle software
- Ability to apply a thorough knowledge of medical terminology, abbreviations, anatomy & physiology, diseases and procedures to accurately review coding assignment and support staff.
- Ability to apply a thorough knowledge of ICD-10-CM, ICD-10-PCS, CPT-4, HCPCS, Revenue Codes, Coding rules and guidelines and proper sequencing to support and audit staff performance
- Proficient use of Microsoft Outlook applications (Outlook, Word and Excel.)
- Ability to communicate clearly and concisely both orally and in writing with all staff, physicians, and patients in all aspects of the job to allow efficiency and promptness for patient care
- Ability to manage staff and coordinate activities, organizing departmental workloads to comply with deadlines and priorities established by the Department Manager
- Knowledge of claim forms and claims filing processes
- Ability to prepare various routine and recurring reports, understanding their content and how the data was pulled
- Possesses analytical skills necessary to perform accurate an extensive review on selected patient accounts and claims
- Ability to coordinate and complete complex projects efficiently, effectively and on time
- Ability to serve as a positive role model, supporting the mission of the organization
- High school diploma or equivalent, required
- Associate or bachelor’s degree in business, healthcare, or related field preferred
- Minimum of 5 years’ experience in Physician and/or Hospital Coding, including experience with audit and quality assurance, along with additional coding credentials either from the American Health Information Management Association or the American Academy of Procedural Coders
- Must have extensive knowledge and understanding of ICD-10-CM/ICD-10-PCS, CPT-4, HCPCS Level II, Revenue Code assignments, coding systems, medical terminology, abbreviations, anatomy & physiology and diseases
- Minimum of 2 years direct supervisory or leadership experience required, 6) the ability to communicate effectively both orally and in writing
- Must have experience with software applications as they apply to the computerized patient record. Consideration will be given to persons with an equivalent combination of education and experience from which comparable knowledge can be acquired
About Boys Town: Boys Town has been changing the way America cares for children and families since 1917. With over a century of service, our employees have helped us grow from a small boardinghouse in downtown Omaha, Nebraska, into one of the largest national child and family care organizations in the country. With the addition of Boys Town National Research Hospital in 1977, our services branched out into the health care and research fields, offering even more career opportunities to those looking to make a real difference.
Our employees are our #1 supporters when it comes to achieving Boys Town's mission, which is why we are proud of their commitment to making the world a better place for children, families, patients, and communities. Unique perks to Boys Town employees and their families include free visits to Boys Town physicians and free prescriptions under the Boys Town Medical Plan, tuition assistance, parenting resources from our experts and professional development opportunities within the organization, just to name a few. Working at Boys Town is more than just a job, it is a way of life.
Date Posted: 11-22-2021
Boys Town National Research Hospital is a tobacco free campus. This advertisement describes the general nature of work to be performed and does not include an exhaustive list of all duties, skills, or abilities required. Boys Town is an equal employment opportunity employer and participates in the E-Verify program. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and/or expression, national origin, age, disability, or veteran status. To request a disability-related accommodation in the application process, contact us at 1-877-639-6003.