Henrico Doctors' Hospital is a 340-bed Level II Trauma Center offering a full range of healthcare services. We offer specialized vascular surgery, Neurosurgery, a comprehensive certified stroke center, orthopedics and groundbreaking diagnostic imaging. We're also a national trendsetter in kidney transplants through the Virginia Transplant Center and as part of the Virginia Institute of Robotic Surgery; we lead the state in minimally-invasive procedures with da Vinci robotic-assisted surgeries.
SPECIFIC ELEMENTS AND ESSENTIAL FUNCTIONS
Responsible for oversight for facility compliance of REGS.GEN.002 (Medicare National & Local Coverage Determination)
Notification/distribution/education of NCD/LCD that apply to the hospital's services, procedures and devices.
Establish responsibility/accountability of compliance with the NCDs/LCDs
Aid in establishing processes/procedures to perform medical necessity review prior to performing a service, procedure, or device & HINN/ABN are given before services are rendered.
Utilize trended data to identify root cause & develop education &/or assist in developing process improvement in workflow to minimize write-offs.
Review MSC write-off report on a monthly basis to identify education/billing opportunities for Pt Access, departmental services, Coding, & validation of NCD/LCD edit application.
Attend designated department meetings related to write-offs and process improvement
Work in conjunction with various departments to establish pricing for CFO approval.
Participate in all "new business" ventures to determine compliance related to Provider Based requirements, charge structure, reimbursement.
Perform post implementation audits to validate charge capture & documentation meet agreed upon criteria and follow reimbursement.
Manage the Labor and Delivery charge capture process
Assist with the Observation charge capture process
Participate in unbilled management
Weekly analysis of accounts on HOLD
Serve as liaison between RPAS/HSC staff and facility related to charge capture/documentation issues
Special projects as assigned by CFO/VP of Finance
REQUIRED SKILLS, KNOWLEDGE AND ABILITIES
Clinical background or understanding of clinical operations
Strong communication skills with hospital and medical staffs
Understanding of services, procedures and devices provided by the hospital
Ability to understand implications of NCDs and LCDs to hospital and hospital departments
Capability to summarize requirements of NCDs/LCDs for education of relevant hospital departments and staff.
Ability to use tools and resources pertaining to NCDs/LCDs which are available on Regs website, CMS' website, Medicare Contractor's website, etc.
Ability to develop and deliver hospital specific educational materials
Ability to manage multiple tasks and projects in a fast paced environment.
Strong communications skills
Professional in appearance and manner
Strong organizational skills
Ability to work well independently and as a group
Required 5 years charging/auditing experience in an acute care hospital.
5 years of nursing or clinical experience in an acute care hospital setting.
Required Nurse (RN/LPN), Allied Health Professional or coding certification with coding &/or charging experience