REIMBURSEMENT SPECIALIST-RADIOLOGY

Scripps is a not-for-profit, community-based health care delivery network in San Diego, California, that includes five acute-care hospitals, more than 2,600 affiliated physicians, an extensive ambulatory care network, home health care and associated support services. As a result of the July 2000 reaffiliation with Scripps Clinic, Scripps now has approximately 10,000 employees and also cares for patients at 12 Scripps Clinic locations throughout San Diego County.Division: Scripps HospitalsDepartment: HEALTH INFORMATIONJob Type: Full-TimeShift Type: DaysShift Hours: 8 Hr ShiftPosition Profile: Accurate assignment of diagnostic and procedural codes for all cases performed in the Radiology Department. Works as a team member with Radiology personnel and Physicians to ensure optimal reimbursement for hospital. Verifies level of care (LOC) for all cases. Abstracts information from records and keys information into SDK. Performs audits of medical records against the itemized bill and also performs special audit requests. Ensures that all charges related to procedures performed in Radiology are entered into the patient accounting system. Coordinates and reports audit outcome regarding charge errors, percentage of savings or losses for Scripps’ facilities, data processing errors, and the performance of hospital charging system, documentation and justification within the medical record and itemized bill.Scripps Green Hospital, located next to Torrey Pines Golf Course above the beautiful shores of La Jolla, has the advantages of a smaller, community-style hospital with a university-oriented focus on research and development in advanced medicine. With 173 acute-care licensed beds and a staff of more than 1000, Scripps Green Hospital offers a wide range of clinical and surgical services.SCRIPPS VALUESWe provide the highest quality of service.Scripps is committed to putting the patient first and quality is our passion. In the new world of health care, we want to anticipate the causes of illness and encourage health behavior for all who rely on us for service. We teach and encourage patients to participate in their care and to make well-informed decisions. We will be their advocate when they are most vulnerable. We measure our success by our patients’ satisfaction, their return to health and well-being, and our compassionate care for dying patients, their families ad friends.We demonstrate complete respect for the rights of every individual.Scripps honors the dignity of all persons, and we show this by our actions toward one another and those we serve. We embrace the diversity that allows us to draw on the talents of one another. We respect and honor the cultural, ethnic and religious beliefs and practices of our patients in a manner consistent with the highest standards of care. All this is done in a compassionate setting. Our goal is to create a healing environment in partnership with all caregivers who are committed to serving our patients.We care for our patients every day in a responsible and efficient manner.Scripps serves as a major community health care resource for San Diego County and, as such, we are accountable for the human, financial and ecological resources entrusted to our care as we promote healing and wholeness. We begin from a base of excellence and collaborate with co-workers, physicians, patients, and other providers to find new and creative ways to improve the delivery of health care services. All members of our community will have access to timely, affordable and appropriate care.
REQUIREMENTS
Preferred Qualifications: Demonstrates proficiency in use of ICD 9 CM and CPT assignments through written exam. Understands insurance terms. Previous hospital or ambulatory surgery coding required. Two to four year degree, (or equivalent experience) in healthcare related field preferred. Experience with PC’s, word-processing, spreadsheet, graphics, and database software applications is desired. Previous auditing experience preferred.Additional Skill Set Requirements:Strong quantitative, analytical and organization skills.
Strong communication and interaction skills with physicians.
Proficient in chart review systems.
Ability to understand and interpret medical records, hospital bills, and the chargemaster.
Ability to understand all ancillary department functions for each of the Scripps facilities.
Ability to utilize and understand computer technology.
Ability to understand basic insurance terms and payment methodologies.
Strong negotiation skills.
Proficient in chart review, level of care (LOC) assignment, clinical record information systems and coding methodologies.
Ability to understand insurance terms, (i.e. HMO, PPO, EOB, Stop Loss, etc.)
Ability to communicate orally and in written form.
Must be team-oriented with strong interpersonal skills.Bachelor degree (or equivalent working experience) in Healthcare related field preferred. Advanced medical terminology, Anatomy/Physiology and coding courses in ICD9CM and CPT, knowledge of medical supplies and medical records.Accredited Records Technician (A.R.T.) or Registered Health Information Administrator (R.H.I.A.) or Certified Coding Specialist (C.C.S.) certification from American Health Information Management Association (AHIMA) or Certified Procedural Coder (C.P.C.).