umhealthwest

Role Description The Coder for Hospital Services, under the direction of the HIM Director, is responsible for accurately and completely coding inpatient and outpatient conditions and procedures by reviewing clinical documentation and diagnostic results, as appropriate, to extract data for billing, internal and external reporting, research, and regulatory compliance as documented in the ICD-9-CM and/or ICD-10-CM Official Guidelines for Coding and Reporting. - Code all diagnoses, treatments, and procedures by translating physician and nursing documentation according to the appropriate classification system for the category of patient encounter. - Maintain 98% coding accuracy based on federal regulations. - Maintain coding productivity within standards as established by record type. - Initiate coding query process as appropriate. - Maintain continuing education credits for corporate compliance regulations and credential requirements. - Assist physicians and other direct patient care professionals in questions regarding level of detail for diagnostic entries, according to the organization’s guidelines. - Foster respect for patient privacy by maintaining confidentiality in all phases of the work. - Participate in departmental quality standards. - Perform other duties as assigned, which may include but are not limited to: maintaining a current knowledge base of department processes, protocols and procedures, pursuing self-directed learning and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management. Qualifications - RHIT, RHIA, CCS, CCS-P, CPC or other professional HIM coding certificate. - Coding software and basic computer software experience. - Effective communication and listening skills. - Ability to contribute to team efforts. Company Description

Role Description Patient Registration Specialists demonstrate excellent customer service, perform efficient and quality work, create the ideal experience for our patients and families, and contribute toward an encouraging and positive workplace culture. They ensure personal, demographic, and insurance information is obtained from the patient or their representative and accurately entered into the electronic health record. Patient Registration Specialists also verify eligibility of patient insurance to ensure it is active for the appropriate date of service and work collaboratively with patients and insurance companies when a potential billing issue exists. Qualifications - High school diploma or G.E.D. - Associate or bachelor’s degree or equivalent experience and education, preferred. - One year or more of work experience in a customer service setting with an excellent attendance and punctuality record. - Work experience in a health care environment, preferred. - Knowledge of group health plans, government health plans, automobile and workers compensation plans, preferred. - Customer-focused interpersonal and communication skills. - Computer literacy and ability to enter a substantial amount of data while maintaining a high level of accuracy. - Work independently in a rapidly changing environment. - Adhere to high standards of teamwork by demonstrating adaptability, flexibility, and consistently sharing information and resources with others. - Demonstrate dependability, initiative, ability to prioritize, and ability to accept direction. - Maintain professional oral and written communication skills. Spell accurately and use proper grammar. - Maintain the highest level of customer service, confidentiality, data integrity, and compliance. - Meet departmental requirements pertaining to attendance and performance. - Meet annual competencies timely. Requirements - Obtain/verify patient demographic, the individual responsible for patient balances, and insurance data in accordance with department guidelines and expectations. - Adhere to patient verification guidelines and accurately input all information into the electronic health record. - Verify insurance eligibility using online systems and manual processes to ensure coverage is active and the patient is listed on the policy. - Identify and resolve patient insurance discrepancies that could result in claim rejections or over-payments. - Communicate with internal and external customers on behalf of the patient to resolve issues. When necessary, involve and guide the patient through the steps needed to achieve successful issue resolution. - Identify patient balances and provide basic-level explanation on the source of the balance. - Identify and escalate financially at-risk patients following unit policy and procedure. - Complete system work queue activity within unit scope. - Respond appropriately to general inquiries from patients and staff. - Recognize process and system issues and take the appropriate steps to investigate and resolve them. Escalate issues to the appropriate person when necessary. - Collaborate with other departments and insurance companies to ensure applicable protocols and processes are followed. - Attend and participate in operational huddles, meetings, and one-on-one discussions. - May work in other locations performing registration functions based on staffing needs. - Based on location, may perform scheduling, arrival, check-in, and applicable prescreening procedures. - Based on location, may provide information and obtain signatures as required by regulatory agencies while in compliance with federal and state regulations as well as other accrediting bodies. - Based on location, may perform document imaging. - Based on location, may collect and post payments. - Based on location and within established guidelines, determine the necessity for immediate attention and conditions of an emergent nature. - Perform other duties as assigned. These may include but are not limited to maintaining a current knowledge base of department processes, protocols, and procedures; pursuing self-directed learning and continuing education opportunities; participating on committees, task forces, and work groups as determined by leadership.

Patient Access Ambulatory Specialist - Patient Access * Days (M-F ) - 40hrs/wk (Remote Opportunity) Requisition #: req11933 Shift: Days FTE status: 1 On-call: No Weekends: No General Summary: Under the direct supervision of the Manager – Patient Access, the Patient Access Ambulatory Specialist is responsible for the verification of benefits, insurance eligibility, estimates, and pre-certification/authorization requirements for all outpatient surgeries, admissions, endoscopy procedures, and heart & vascular testing. The Specialist works closely with insurance companies, utilization review nurses, and physician offices to ensure accurate and timely billing for reimbursement. Requirements: - High School diploma, GED, or equivalent required. - College Education: 1-2 years preferred. - Certified Healthcare Associate Certification (CHAA) preferred. - 2-3 years prior experience in Revenue Cycle or equivalent education. - Medical Terminology preferred. - Knowledge of CPT-4 and ICD-10 recommended. - Coding certification preferred. Essential Functions & Responsibilities: - Responsible to obtain and/or verify demographic, financial, and insurance information from patients and/or their representatives to ensure prompt insurance reimbursement. - Responsible to verify benefits, insurance eligibility, pre-certification/authorization requirements and obtain consents when appropriate. - Utilize RTE and/or websites to validate and confirm authorizations, coverage of benefits and eligibility status while adding payer specific information into the Auth/Cert screen in Epic. - Responsible to create estimates and educate patients of their out-of-pocket costs, deductibles or co-insurance and collect when appropriate. - Responsible for daily reconciliation of cash drawer at the end of each shift. - Provide timely notification to payer of admission status based on the specific payer requirements. - Deliver initial Important Message of Medicare (IMM) letter to patients at the time of admission. - Ensure authorization for required procedures per payer has been completed and entered in Epic prior to surgery for inpatient, surgery admits, and observation patient class. Include all components of the authorization within the Epic Auth/Cert screen to ensure accuracy such as insurance, auth number, valid auth date range, and CPT codes. - Provide friendly, timely customer service to both internal and external customers seeking information regarding the authorization, notification, and coverage. - Provide information to patients regarding financial support that may be available and coordinate with a Financial Counselor for follow up. - Provide detailed notes to ensure a smooth transition of the Revenue Cycle process on every chart. - Performs other duties as assigned. These may include but are not limited to: Maintaining a current knowledge base of department processes, protocols, and procedures, pursuing self-directed learning, and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.