| Location: NHRMC Orthopedic Hospital Department: Mobile Integrated Health Full Time Equivalent: FTE: 1.000000 Work Type: 64 to 80 Hours Pay Period Work Schedule: 8HR ROTATE - Rotating shifts Exempt from Overtime: Exempt: No |
| Summary:
Under the general direction of the Mgr-Clinical Outcomes & Compliance, this specialist is responsible for accurate processing, and reimbursement-associated data entry for all Mobile Integrated Health service encounters including air & ground transports, treat and release, telehealth encounters, immunizations, scheduled patient visits, and transport refusals. Performs medical record review of each patient record for reasonableness and necessity of ambulance service as well as for demographic information, mileage, etc. Ensures the presence and completeness of necessary forms. Works with NHRMC staff and outside customers to obtain any necessary clarification or documentation. This person requires little supervision and performs all work independently, with a high degree of autonomy. All work is carried out following the department’s approved policies and procedures. This position is an advanced-level technical position within Mobile Integrated Health.
Responsibilities:
1. Responsible for maintaining knowledge of all current federal and state rules, regulations, and guidelines related to mobile integrated health (ambulance, air medical, & non-transport prehospital care) coding and billing. 2. Ensures that all charts are accounted for as well as complete with and correct for all documentation necessary for reimbursement purposes (i.e. PCS, ABN, AOB, pre-authorization, etc.) before submission to the billing partner(s). 3. Reconciles physician and prehospital provider records following telehealth visits and completes appropriate reimbursement records. 4. Create patient medical record numbers and/or encounters such that prehospital records align with the network electronic medical record system. 5. Maintains 90% compliance processing all patient care records within three (3) business days of record completion. Records are either send to the appropriate billing partner or flagged for clinical crew correction. 6. Responsible for maintaining departmental compliance audit scores at a passing level. 7. Ensures all insurance-required prior authorizations are processed submitted before, or the same day of, the patient transport. 8. Collaborates with direct patient care professionals regarding documentation that supports the need for ambulance service, etc. according to CMS and departmental guidelines. Collaborates with Regional Transfer Center, Case Management, Compliance, and other applicable areas as needed. 10. Educates the clinical teams on CMS requirements and documentation expectations as needed. Prepares and provides in-services as needed or as requested by the manager to internal and external partners. 11. Fosters respect for patient privacy by maintaining strict confidentiality and HIPPA compliance in all phases of work. 12. Demonstrates Standards of Performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence. 13. Performs other duties as assigned. |
| Credentials:
Education:
Essential:
* High School Diploma
Other information:
1. Education: • Minimum high school diploma or GED required • Working knowledge of medical terminology, clinical medical concepts, and human anatomy and physiology required • Preferred: Associates degree in medical coding or similar health-related field. 2. Licensure/Certification: • Current credentialing in medical coding (Certified Coding Associate, Certified Coding Specialist, etc.) by an accredited organization (AACP, AHIMA, NAAC, etc.) preferred within 24 months • North Carolina Paramedic certification preferred. 3. Experience: • One year of experience with medical coding required • Experience in EMS patient care charting and EPIC eMR and systems is preferred. • Proficiency with Word and Excel required. |
