Overview

Built-in 1973 Dignity Health Methodist Hospital of Sacramento is committed to providing daily excellence in health care for residents of Sacramento’s southern suburbs including the Elk Grove Wilton and Galt communities. Methodist Hospital is home to a 158 acute-care bed facility with 1120 employees 283 medical staff and 29 Emergency Department beds. Methodist Hospital also owns and operates Bruceville Terrace – a 171-bed sub-acute skilled nursing long-term care facility adjacent to the hospital that provides care for the elderly as well as those requiring extended recoveries. Methodist Hospital is home to the Family Medicine Residency Program an accredited and nationally recognized program which provides resident physicians with specialty training in primary care family medicine. Together the hospital and residency program implemented a ground-breaking curriculum addressing the identification treatment and assistance of human trafficking victims and created a one-of-a-kind health clinic for victims the Human Trafficking Medical Home.

Responsibilities

The incumbent is knowledgeable in billing procedures with a variety of payer sources. Has knowledge in the current ICD and CPT coding in a clinic setting. The incumbent is responsible for performing all required testing audits and verifies accuracy of the documentation to ensure medical necessity for appropriate charges are within the electronic medical record prior to releasing charges. Works closely with the finance accounting & coding departments to ensure claims are populated with correct/proper coding based on Medicare and Medi-Cal billing guidelines. Responsible for updating CDM dictionary. Educates instructs and updates providers regarding the need to accurately document care to support ICD coding and level of billing. Acts as a resource for questions regarding coding/billing. Performs other duties as assigned.

•Demonstrates attention to detail to minimize coding errors, performs compliance and quality audits, and ensures accurate billing

•Print and use the Arrived Patient List to capture all encounters

•Cerner PCA Charge Viewer: Review each Encounter to make sure there is a diagnosis charge and the note is CoSigned by a Preceptor

•Check BP Codes for HPMG Incentive

•View Office Visit Charges (Delete Duplicates)

•Validate Modifiers (GC – w Faculty / GE –w/o Faculty Modifier)

•Cerner PCA Pharm Charge Credit Tool: Validate Vaccine CDM, NDC (Delete Duplicates)

•Correct payer information and accurately change account information to ensure proper billing procedures will take place.

•Send out a report of Non-Completion Encounters: E-Mail the list to team. Notify provider in person or via phone.

•Prepare audit reports via Cerner Discern; audits in a timely manner and provides recommendations for corrective action and a timeline

•Utilizes Hill Metrics to validate the quality measure due for the patient and documents on form

•Ensure HEDIS Quality inquiries are being completed by assigned physician

•Denial letters: Review encounter for errors and correct them.

•Ensures that the CPT and HPC codes for the clinic are current

•Requests changes to the CDM to both DHMF and Cerner

•Promotes positive and professional attitude in all interactions

•Serves as a resource for new physicians by assisting in the new physician education process

•Check emails daily and respond timely.

•Ensure that held or submitted claims are being aggressively worked; billing edits are current and accurate.

•Manages through monitoring and tracking of corporate compliance initiatives related to coding and revenue

•Contributes ideas to the departmental work plan and participate in departmental staff meetings

•Works with CSS and Clinic Medical Director to assist in EHR training for providers

•Assists the organization in reviews relating to internal or external investigations

•Promotes positive guest relations for the clinic in attitude and professionalism with guests, patients, physicians, and other staff members. •Demonstrates concern for patients, co-workers by being prepared to work in the work area on time

•Maintains awareness of cultural, disorder, or age differences in patients or guests, and promotes sensitivity awareness so that a positive public image is portrayed at all times.

•Patient Privacy: Demonstrates work place practices that maintain patient privacy and confidentiality.

•Use CultraLink or Interpreter as needed for translation

•Consistently follow regulatory, Joint Commission, Dignity Health, and hospital policy requirements relating to the disclosure of and/or access to Protected Health Information (PHI).

•Review Network Usage Policy and signed acknowledgment form annually.

•Patient Information Security: Demonstrates work place practices that maintain the security of protected health information including maintaining PHI in a secure work environment, reporting suspected breaches of PHI security to Management or Privacy Offices, and following all policies and regulatory requirement for the safeguarding of PHI.

• Perform other duties as assigned by Clinic Manager

Qualifications

Minimum

• High school diploma (or equivalent) required

• One (1) year of experience in a medical environment handling insurance claims required

• Knowledge of Medical Terminology; use of CPT, ICD codes and HCPC coding manuals Excellent communication skills, verbal and written

• Ability to take instruction and follow established procedures

• Ability to exercise independent judgment, common sense, initiative and troubleshoot

• Ability to work under pressure in a fast-paced environment, complete tasks in a timely manner, and work without close supervision

• Ability to make accurate arithmetic computations and comparisons and use standard alphabetic and numeric keyboards

Preferred

• CPMA preferred

• Working knowledge of Cerner Power Chart preferred

• Experience with IDX systems preferred

• Strong interpersonal communication skills preferred

• Experience presenting to Providers and Coders on a one-on-one and group base preferred

Pay Range

$21.70 - $29.84 /hour

We are an equal opportunity/affirmative action employer.