This position is responsible to: audit patient medical and billing records to determine that documentation and items billing are appropriate; represent Children's in external billing audits with payors; and identify potential billing, charging or documentation issues. This is accomplished by: auditing patient medical and billing records; and completing and finalizing audit results with external payor auditors. Expected results include: accurate completion of audits in a timely manner; follow through to ensure that audit adjustments are made and corrective actions are taken to address identified billing, charging, and documentation issues; and represent Children's in a competent and professional manner with external clinical auditors.
The following describes the basic position duties that an employee MUST be able to perform for this role. This information is intended to be descriptive of the key responsibilities of the position. The list of essential functions below DOES NOT identify all duties performed by any single person in the position.
Requires depth within a specialized, critical discipline and/or breadth of substantive professional knowledge that crosses disciplines within the professional field
Interprets internal/external business challenges and recommends best practices to improve products, processes or services
May lead functional teams or projects with moderate resource requirements, risk, and /or complexity
Leads others to solve complex problems; uses sophisticated analytical thought to exercise judgment and identify innovative solutions
Impacts the achievement of customer, operational, project or service objectives; work is guided by functional policies
Works independently, with guidance in only the most complex situations
Communicates difficult concepts and negotiates with others to adopt a different point of view
JOB SPECIFIC RESPONSIBILITIES:
Read and interpret patient medical records to determine that all items billed were documented and that all care documented was correctly billed to the patient. Report audit findings in agreed upon format.
Identify potential billing, charging or documentation errors/issues, research as appropriate and interact with customers to determine corrective actions (if any).
Conduct other audits as assigned.
Follow up on audit findings and billing compliance issues to determine that necessary adjustments have been made and that corrective actions identified have been implemented.
Interact as appropriate with all external auditors, internal customers and hospital departments.
At least 2 years’ experience as LVN or RN Required
At least 2 years’ experience in utilization review, nurse audit or other clinical audit function required
Two-year Associate's degree or equivalent experience required
Four-year Bachelor's degree or equivalent experience preferred
LICENSES and CERTIFICATIONS:
LVN or Registered Nurse required
Specific Knowledge, Skills and Abilities:
Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.
Develop and use collaborative relationships to facilitate the accomplishment of work goals.
Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.
Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
Effectively manage one's time and resources to ensure that work is completed efficiently.
Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self impose standards of excellence rather than having standards imposed.
Assimilate and apply new job-related information in a timely manner.
Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.
I get such great satisfaction knowing that I am able to bring in new tests to our smallest and most precious patients, providing quick and accurate results. Whether it is the medical staff, nursing, pharmacy or lab, we all work together.
Point of Care Coordinator