1. Retrospectively analyzes accounts with payment variances or denials to ensure proper contractual payments amounts and accurate SDK prorations in an effort to achieve department recovery goals. 1.1 Identify trends/payer issues via payment variance function or denial review, documents and summarizes findings. 2. Develop professional working relationships with payer repre

1. Reviews medical records of hospitalized patients to identify the most appropriate principle diagnosis and to assign a working DRG. Performs initial reviews, concurrent reviews and retrospective reviews to ensure the DRG accurately reflects the principal diagnosis and all comorbid conditions after study. 1.1 Completes the initial review within 24 48 hours of admission.

1. a. follows established standards of nursing practices and implements facility policies and procedures. b. interprets existing policies and procedures to other licensed staff, nursing assistants, residents, families and physicians. c. assumes responsibility for compliance with Federal, State and local regulations within the assigned unit. 2. a. obtains report from nurse

1. Exhibits Ability To Prioritize Activities. 2. Assists Others In Obtaining And Sharing Pertinent Information. Notifies Appropriate Rn Or Department Of Stat Orders. Coordinates Desk Communication Activities During A Code Or Other Emergency Situation. 3. Knows Protocol Requirements And Sequences For Lab Tests, Radiology Procedures, The O. R. And Their Checklist Which Incl

1. Directly supervises the work activities of assigned home health agencies? billing staff. Monitors work queues and ensures the completeness and timeliness of assigned function. 2. Works with Home Health Operations to identify trends, reduce errors, and enhance revenue collections. 3. Serves as a resource for clinical staff and agencies? coordinators to obtain informatio

1. Retrospectively analyzes accounts and third party remittance in assigned work file to make sure we get paid correctly. 1.1 Using knowledge of capitated and managed care contracts verifies that payment amount expected is correct (i.e per diem, DRG payment, percentage payment programs, case rate payments and various UB92 Revenue codes as well as fee for service payments)

1. Schedule, confirm, coordinate, and provide support to patients for in office and external appointments. 2. Contacts patients by phone to remind of upcoming appointment(s), to ask follow up care questions, and to provide special instructions if needed. Cancels and reschedules appointments as needed. 3. Must be able to communicate with patients, families, facility staff,

1. Follows All Laboratory And Hospital Safety Policies. 2. Operates All Department Equipment Safely And According To Manufacturer Guidelines. Performs Preventative Maintenance And Troubleshoots Instrument Failures To Best Of Ability Alerting Proper Personnel Of Equipment Problems. 3. Follows All Department Qc Procedures And Troubleshoots Qc Failures With Proper Documentat

1. Courteously & Professionally Processes Patients In And Out Of The Dept. Obtains Necessary Documentation For Insurance Authorization, And Pre Certification. Demonstrates Knowledge Of Existing Insurance Requirements. Enters Orders In Meditech. 2. Accurately Schedules Patient Appointments And Coordinates All Necessary Follow Up For Patients Including Scheduling With Other

1. Courteously & Professionally Processes Patients In And Out Of The Dept. Obtains Necessary Documentation For Insurance Authorization, And Pre Certification. Demonstrates Knowledge Of Existing Insurance Requirements. Enters Orders In Meditech. 2. Accurately Schedules Patient Appointments And Coordinates All Necessary Follow Up For Patients Including Scheduling With Other

1. Conducts Interviews With Patients In Person Or By Phone. 2. Obtains Accurate Demographic And Financial Information. 3. Collects Co Pays. 4. Performs Icd(X) Coding. 5. Performs Medical Necessity Screening And Communicates With Physician?S Office To Obtain Correct Diagnosis. 6. Prepares All Related Forms, Patient Card And Id Bracelet. 7. Receives And Disseminates Informa

1. Exhibits Ability To Prioritize Activities. 2. Assists Others In Obtaining And Sharing Pertinent Information. Notifies Appropriate Rn Or Department Of Stat Orders. Coordinates Desk Communication Activities During A Code Or Other Emergency Situation. 3. Knows Protocol Requirements And Sequences For Lab Tests, Radiology Procedures, The O. R. And Their Checklist Which Incl

1. Communications and Reporting 1.1 Ensures that regular meetings are held with physicians to discuss status of practice operations, new programs/services and to review financial data. 2. Operations 2.1 Assists in the development of a short and long term strategic plan for the practice. 3. Financial Management 3.1 Prepares and/or oversees the preparation of operational bu

1. Service Excellence Creates a great "First Impression" by demonstrating exemplary customer service skills for all customer groups including patients, families/friends, physicians, staff and support department personnel. Adheres to the "I Am YNHH" service excellence pledge. 1.1 Interacts with patients, families/friends, physicians and staff, in a helpful, courteous, plea

1. Develops annual sales plan for primary and secondary service area target companies, working with management to insure validity of the plan with respect to strategic goals of Occupational Medicine and Wellness Serivces. 2. Makes face to face contacts with all clients and potential clients in the primary and secondary territories in accordance with quarterly and annual s