Medical Coding Charge Capture Specialist
Vanderbilt University

Introduction:

The Charge Capture Specialist position for the VUMC Department of Charge Integrity will work directly with the Assistant Director of Charge Integrity. The position will be responsible for performing routine and special project analysis to assure the accuracy and completeness of charges captured for insurance and patient billing of inpatient and outpatient hospital services.

Job Description:

Key Functions and Expected Performances include:

• Performs analysis of charges generated from ancillary subsystems to the insurance claim and/or patient statement to verify the accuracy of charges

• Performs analysis of charges that correlate with documented medical/nursing interventions

• Identifies appropriate charges on the patient bill, utilizing documentation from the medical record

• Verifies and resolves discrepancies by utilizing the tools and resources available, e.g. Medipac/Epic billing systems, medical record documentation, Charge Master data, Patient Accounting/VMG Business Offices and/or contacting the appropriate internal department

• Identifies deficiencies or discrepancies in nursing and/or physician documentation that affects billing and notifies the originator of the incorrect documentation to allow for proactive improvements related to charge capture

• Demonstrates and applies the various reimbursement methodologies (DRGs and APCs) to secure optimal reimbursement. Understands the relevance and impact of correct units, modifiers on reimbursement under the various methodologies

• Remains knowledgeable about CMS and Fiscal Intermediary medical necessity guidelines and their impact on reimbursement

• Takes an active role in addressing medical necessity issues that impact the quality of care and hospital reimbursement

• Coordinates work and communicates and proactively resolves critical charge capture and coding issues to multiple management lines including but not limited to: Medical Information Services, VMG Coding and Charge Entry, Patient Accounting/VMG Business Offices, Department of Finance/Patient Care Center Financial management team, VUMC Clinical Administrators, Charge Master/Accuracy Specialists and Information Management personnel

• Collaborates with the clinical department administrators in the development and implementation of educational activities related to charge capture improvement projects

Required Qualifications:

This position requires a Bachelor’s degree with emphasis in Business Administration, Accounting, Healthcare Administration, Nursing, Health Information Management or other related healthcare concentration area with a minimum of 4 years of relevant experience.

Required Experience and Skills:

• Knowledge and understanding of hospital revenue cycle operations (registration, charge capture, health information management, claims, payment posting)

• Knowledge of regulatory publications, how to access and interpret

• Working knowledge of medical terminology

• Solid oral and written communication skills

• Excellent analytical and problem-solving skills

• Experience with Microsoft Office (Word, Excel, PowerPoint)

• Hospital Billing and UB-04 Experience

Preferred Qualifications:

Preferred Experience and Skills include:

• Coding experience in a hospital inpatient and outpatient setting and professional certification as a RHIA, RHIT, or CCS

• Candidates with advanced business or healthcare related degrees and professional work experience in revenue cycle operations and/or clinical operations

• Knowledge of government and commercial payer requirements to ensure accurate and compliant charging and billing of hospital inpatient, outpatient, surgical and ancillary services

• Knowledge of CPT, HCPCs, and revenue codes

• Knowledge of APC, fee for service, and DRG payment methodologies

• Experience in utilizing computerized data analysis techniques/tools to identify charge capture issues

• Working knowledge of VUMC or other major academic medical center clinical operations and related charge capture processes

• Proficient User of Business Objects, Medipac, and EPIC

Compensation/Benefits:

This is a full-time; exempt position. Salary is commensurate upon years of education and experience. Background screens will be performed and education will be verified prior to employment. Please be prepared to provide required information and/or documentation.

Vanderbilt is a smoke-free workplace in compliance with the Non-Smoker Protection Act, Tennessee Code Annotated 39-17-1801-1810. In accordance with that law and Vanderbilt policy, smoking is prohibited in all buildings on Vanderbilt property and on the grounds of the campus with the exception of designated outdoor smoking areas. Vanderbilt is an equal opportunity, affirmative action employer.

Instructions for Resume Submission:

To apply, contact Richard Le by phone or email.
Phone: 615-875-8392
Email: richard.le@vanderbilt.edu

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The Forms Account Representative manages all ongoing project activities related to the development, implementation, and maintenance of new and existing Forms business at HMS client sites. Specifically heavy involvement with Health Information Management and Patient Access Departments.

Job Description:

• Works cooperatively with the Forms contact at each client hospital to install Electronic Documents at the client site

• Performs “on–site” HIM / Medical Records paperless assessments at client sites

• Manages Forms projects as described in amendment/contract by ensuring that all terms of the agreement are adhered to by HMS and client

• Reports all project issues such as client requested changes or additions to the Design Team of the Document Management Services team

• Determines if client requested changes or additions to Forms projects are to be billed to client

• Works with hospital personnel involved with any aspect of Forms project to ensure full coordination and cooperation under the HMS/hospital statement of work

• Provides all necessary training and implementation of services/products offered through Document Management

• Identifies potential Professional Services consulting opportunities for HMS staff

• Promotes HMS Scanning and Archiving solutions as well as other company products that might assist client operations

• Identifies potential opportunities as well as provides consulting services on HMS Archiving solutions, Integrated Forms, and Process Enhancements as needed

• Works closely with the client HIM staff and Document Management Services team to assure the best possible outcome for the client and HMS

• Account management and follow up

• Assist with special HMS functions, as requested

Required Qualifications:

• Ability to travel 50%

• Minimum of 2 years hospital operations experience in the HIM Department

• HIM Experience management or non management with a strong knowledge of the deficiency process

• Strong computer skills in Microsoft Office applications (i.e., Word, Excel, PowerPoint, etc.)

Preferred Qualifications:

• Knowledge in, and the ability to apply, the principles of hospital workflow, project management and change management

• Demonstrated hospital, facilitation, communication and presentation skills

• Negative pre-employment drug tests

• Criminal and MVR backgrounds meet our company hiring criteria

• Good interpersonal skills that include the ability to effectively communicate in both writing and verbally

• Excellent written, proofreading and verbal communication skills

• Must be detail oriented, organized and have the ability to multi-task

• Ability to demonstrate supportive relationships with peers, clients, partners and corporate executives

• Must be flexible with a “can do” attitude and have the ability to remain professional under high pressure situations

• Ability to retain and protect confidential material. Negative pre-employment drug tests

• Criminal and MVR backgrounds meet our company hiring criteria

Please email all interested resumes/applications to Rich Singer at rsinger@sentrytn.com.

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Senior Compliance Specialist
Mountain States Health Alliance

Introduction:

MSHA Corporate Audit and Compliance Services desires to employ a certified coder with hospital experience to perform coding audits, conduct education, and provide coding advice to hospital departments.

Job Description:

The Senior Compliance Specialist conducts compliance reviews, special assignments, and research and advisory projects in order to further ensure compliance with laws and regulations by MSHA and its subsidiaries. The Senior Compliance Specialist conducts investigations of suspected and known fraudulent or abusive activities. The Compliance Specialist is responsible for the development of review programs, completion of test work, and report writing, subject to final approval by the Director of Corporate Audit and Compliance Services. The Senior Compliance Specialist will frequently interface with Senior Management and other personnel at all levels of the organization. In addition, the Senior Compliance Specialist will have occasional contact with Board Members, legal counsel, consultants, federal, state, and local agencies, vendors, patients, physicians and their staffs, industry peers, and other parties.

This position is project-oriented and not routine; it requires self-motivation, the flexibility to deal with unfamiliar situations, and good organizational and interpersonal skills. Most of the projects are "first-time" assignments. This position requires concentration, close attention to detail, objectivity, resourcefulness, the ability to maintain confidentiality of sensitive information, and the ability to work within specified time budgets.

This is a salaried professional position. This position is governed by standards for the internal auditing profession and compliance professions, which are established by the Institute of Internal Auditors (IIA) and Health Care Compliance Association (HCCA) as set forth in the IIA's Standards for the Professional Practice of Internal Auditing, the IIA Code of Ethics, and the HCCA's Code of Ethics for Compliance Professionals.

Required Qualifications:

• Bachelor's degree in a related field

• Coding Certification

• Hospital experience

• Minimum of 3 years related experience

Preferred Qualifications:

CPC-H or CCS Certification Preferred

Education Qualifications:

• This position requires a Bachelor's degree with a major in a business or healthcare related field or an experienced Registered Nurse (Associate Degree or Bachelor Degree).

• Professional certification is preferred, but not required, for this position [for example, Certified Internal Auditor (CIA), Certified Public Accountant (CPA), Certified Fraud Examiner (CFE), Registered Nurse (RN), Certified Coding Specialist (CCS), Accredited Record Technician (ART), or Registered Records Administrator (RRA)]

• This position requires a minimum of three years auditing experience, preferably as a health care internal auditor or nurse auditor

• Additionally, health care experience in third party reimbursement, billing, or coding is strongly desired. Familiarity with health care laws/regulations and third party billing/coding knowledge is necessary

• Experience with personal computers required. This would include having a working knowledge of word processing, spreadsheet, and audit software as well as experience with on-line systems

Instructions for Resume Submission:

Please submit applications to www.msha.com.

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