REIMBURSEMENT SPECIALIST in CANTON, Ohio at Aultman Health Foundation

Aultman Hospital

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 3 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 5 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.

Responsible for maintaining and monitoring charges for 3 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.

• High School Diploma or equivalent.

• Minimum of 2 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.

• 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.

• Review all clinical documentation daily for observation and inpatients for correct admission status.

• Identify and correct all registration errors regarding account status.

• Review all discharged observation and inpatient encounter documentation to charge drug administration/infusion charges according to coding guidelines.

• Complete facility charge ticket on all ER admits for level charges and batch charge enter any procedures performed in our 5 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.

• 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.

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.

Demands

Frequency

Remarks

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.