Loretto Management Corporation

Specialist, Medical Records

Department
Sedgwick Heights - Admin - Sedgwick
Type
Regular Full-Time
Shift
First
Weekends Required?
No

Overview

 

Under the general direction and supervision of the Health Information Director, the Medical Records Specialist will be responsible for analyzing documented clinical data to identify cases where additional provider documentation is needed to better reflect the patient’s clinical picture, severity of illness, etc. In addition, the Specialist will identify, collect, assess, monitor and review documentation and encounter coding as it pertains to facility and physician billing to ensure proper diagnosis and procedural coding are coded correctly based on the conditions documented in the clinical notes. Loretto is seeking to identify coding issues and deal with them in a timely manner while educating providers and their staff on how to prevent future issues.

 

Responsibilities

  • Conducts initial reviews of various medical record documentation to ensure the capture of all appropriate diagnoses/procedures related to reimbursement and compliance standards.
  • Routinely reviews medical record information and coding to identify appropriateness based on ICD coding guidelines, clinical documentation standards, ensure current diagnoses are in the resident’s medical record cumulative diagnosis index and billing system.
  • Verifies and ensures the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered.
  • Identifies trends/problems in medical documentation and recommends solutions to the Health Information Director/designee.
  • Queries provider documentation to ensure capture of all applicable diagnoses/procedures related to reimbursement and compliance standards. Reports any trends and/or issues to the Health Information Director/designee.
  • Identifies medical services provided but not adequately documented in medical record. Advises supervisor and clinicians of deficiencies to ensure accuracy, completeness and capture of maximum reimbursement.
  • Prepares provider profiles on a monthly basis for physician billing, prepares utilization and various statistical reports and in collaboration with Health Information Director/designee assists in analyses as appropriate.
  • Attains authorizations for insurance for outpatient services.
  • Keeps current with coding and reporting requirements and performs all necessary duties to maintain compliance.
  • Keeps current with correct coding initiative edits and works with the finance department to ensure the adjudication system is updated appropriately.
  • Updates physician fee schedule yearly.
  • Acts as a resource for Loretto finance departments for reimbursement, compliance, and coding issues.
  • Completes audits related to reimbursement coding compliance, utilization management and QA related to record maintenance.
  • Actively participates in staff meetings or other meetings as requested by supervisor. Assists as requested in relevant committees, task forces and special projects to promote quality improvement initiatives.
  • Prepares release of information requests for outside facilities, resident/families and law offices.
  • Maintains release of information database in adherence with HIPAA.
  • Completes the assembly and analysis of discharged medical records for compliance according to procedure and send notice of incomplete records to the appropriate departments.
  • Provides Medicare Part A cut letters to residents within two days prior to the skilled service ending to be in compliance with CMS.
  • Complies with and understands all policies and procedures and third party agency regulations (HIPAA, DOH, etc.).
  • Performs light filing and archiving as needed.

Qualifications

  • Required; Associate’s Degree with RHIT credentials or RHIT eligible.
  • Minimum 2 – 3 years of coding experience preferred, combination of outpatient and inpatient (hospital setting) preferred.
  • Prior experience with Electronic Medical Records highly desirable.
  • Proficiency with ICD diagnosis coding.
  • Knowledge and experience in all aspect of health information management highly desirable.
  • Strong organizational and analytical skills with ability to prioritize work.
  • Strong written and verbal communication skills; strong analytical, organizational and time management skills required.
  • Accurate data entry skills required. Proficient with MS Office and able to learn new applications rapidly.

 

An equivalent combination of education and experience which provides proficiency in the areas of responsibility listed above may be substituted for the above education and experience requirements.

 

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