Resource Utilization/Classification Tech - HIM Reimbursement Specialist - PT - Remote

POSITION PURPOSE:

The HIM (Resource Utilization/Classification Tech/Reimbursement) Specialist coordinates with physicians' offices and as necessary with patients, the collection of pertinent information necessary to determine medical necessity of all outpatient procedures/tests to assure reimbursement. Is responsible for assuring all departments that schedule tests/procedures coordinate scheduling with the resource utilization staff. Coordinates with physicians' offices/Nursing Units/Patient Admissions the appropriate admission classification of patients receiving treatment as inpatients, observation or same day surgery.

Uses a customer-focused approach in response to charge entry, billing and collection inquires for hospital related services. Prepares necessary paperwork for billing of hospital services and responds to patient concerns regarding such services or billing. Serves patients of all ages.

Details:

Your best life. Our one purpose.

At MercyOne, we own our actions to achieve our larger goals. We invest in great people and ask that you make each experience your responsibility.

What we offer:

We care about your well-being, both physical and mental, which is why our benefit package includes:

• Wellness programs
• Education reimbursement
• Personalized health insurance plans including dental and vision
• Paid time off
• Long- and short-term leave
• Retirement planning
• Life insurance coverage

What you will do:

• Demonstrates specific customer focused behaviors to include attitude, privacy/confidentiality, communication skills, and professional behavior.
• Performs E/M, infusion/injection and procedure charging on all emergency room visits.
• Reviews and add charges for OBS accounts for correct charging of OBS hours, infusion/injection and procedures.
• Assigns appropriate PACU charges for AMB and Surgical patients.
• Responsible for variety of other charges: Wound care, Professional charges, Dialysis and Misc. Lab charges
• Works claims hitting LCD/NCD edits.
• Responds to requests to verify charging is correct.
• Complete audits to ensure charging is accurate and consistent among chargers.
• Complete audit to ensure LCD/NCD policies are followed.
• Complete audit to ensure FCT is correct and consistent among chargers.
• Post discharge review on Code 44 accounts and patient status changes.
• Receives and processes all outpatient requests for diagnostic tests/procedures from physician offices.
• Notifies physicians of non-covered test/procedures and prepares ABN for patient signature.
• Performs billing procedures for Mercy Medical Center hospital services. Generates billing information accessing electronic systems and following established procedures.
• Initiates follow up procedures on unpaid claims according to hospital policy. Reviews all unpaid claims on a regular scheduled basis with insurance companies.
• Responds to third party requests, attorneys, etc. within appropriate time frames.
• Responds to routine customer concerns, as well as, those needing special attention. Consults with medical records, Medical Auditor, Registration to resolve coding, charging and billing issues.
• Completes documentation for adjustments to patient accounts.
• Reviews credit balances to determine overpayment, corresponds with insurance companies and initiates repayment according to procedures.
• Maintains knowledge of all equipment and software applications within the billing area.
• Strives for individual performance excellence within the job in order for the department to achieve the days in A/R goals etc.
• Performs other related duties as assigned.
• Demonstrates activity to impact change within your department and with other departments.
• Promotes and establishes effective relationships within the department, with other departments, physicians, and with hospital guest and clients.
• Takes an active role in enhancing abilities to carry out job functions through personal and professional/job-related growth and development.
• Fulfills continuation of care requests.
• Responsible for phone coverage and general office duties.
• Willing and ready to assist other team members with their duties as time permits or need arises.
• Readily identifies work that needs to be performed and completes it without needing to be told.
• Other duties as assigned (duties may be added, deleted or changed at any time).

What we are looking for:

• High school graduate.
• RHIT, LPN, RN or equivalent experience/training.
• Basic knowledge of ICD-10 and CPT coding.
• Health information experience preferred.
• Excellent communication skills, both oral and written.
• Excellent interpersonal skills.
• Knowledgeable in ICD-10 and CPT coding.
• Knowledgeable in health information procedures/functions/procedure.
• Clinical background to include knowledge in ancillary tests/procedures, surgical procedures, and medical terminology.
• Knowledgeable in Medicare Rules and Regulations, as well as, LMRP.
• Must possess computer skills.

MercyOne Eastern Iowa provides exceptional, personalized care to Dubuque, Dyersville, Elkader, Clinton and surrounding areas providing more than 300 licensed beds. MercyOne Eastern Iowa operates four medical centers in Dubuque, Elkader, Dyersville and Clinton. Our facility in Clinton has branches in DeWitt, and Fulton specializing in family medicine and Savanna Home Health & Hospice Care based in Illinois.

• MercyOne Dubuque Medical Center
• MercyOne Dyersville Medical Center
• MercyOne Elkader Medical Center
• MercyOne Clinton Medical Center

With a history dating back more than 130 years, MercyOne Eastern Iowa has grown through expansions, acquisitions and consolidations to help provide exceptional, personalized care to our communities. Our four medical centers employ over 2,000 colleagues and medical staff improving access and creating an even higher level of care coordination to benefit patients and communities throughout the region.

Our Mission:

We, Trinity Health, serve together in the spirit of the gospel, as a compassionate and transforming healing presence within our communities.

Our Core Values:

• Reverence
• Commitment to Those Who are Poor
• Safety
• Justice
• Stewardship
• Integrity

Our Vision:

• We will be the most trusted health partner for life.

Our Actions:

As a Trinity Health colleague, I will:

• Listen to understand.
• Learn continuously.
• Keep it simple.
• Create solutions.
• Deliver outstanding service.
• Own and speak up for safety
• Expect, embrace and initiate change.
• Demonstrate exceptional teamwork.
• Trust and assume good intentions.
• Hold myself and others accountable for results.
• Communicate directly with respect and honesty.
• Serve every person with empathy, dignity and compassion.
• Champion diversity, equity and inclusion.

Our Promise:

• We Listen.
• We Partner.
• We Make it Easy.

MercyOne Dubuque Medical Center and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, physical disability or any other classification protected under local, state or federal law.

Our Commitment to Diversity and Inclusion

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.