The incumbent performs highly technical and specialized functions for the Cherokee Indian Hospital Authority. The employee reviews, analyzes diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments. The primary function of this position is to review the ICD-9-CM, and/or ICD-10-CM, CPT and HCPCS coding for reimbursement. The Business Office functions are a primary source for data and information used in health care today, and promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement. The Business Office functions also ensure compliance with established guidelines, third party reimbursement policies, US Government regulations and accreditation guidelines.
Job Duties and Responsibilities
Complexity of Duties
Duties are highly complex, varied, require planning and coordinating several activities at one time, and demand the use of problem solving skills and analysis of circumstances to develop appropriate actions. Subject to frequent interruptions, in person and by phone, which require varied response.
Contact with Others
Internal contacts occur on a regular basis with departmental personnel. External contacts include clients, families, health professionals, and general tribal population, as well as other tribal entities. Purpose for contacts is for the exchange of information requires tact, courtesy, and professional decorum. Contacts include agencies both federal and state including Indian Health Service, Medicaid, Medicare, and other private insurance companies, attorneys, auditors, and clearing house contractor. Requires the ability to organize work and deal effectively with the public and federal, state, and tribal agencies.
Consistently demonstrates superior customer service skills to patients/customers by displaying Spotlight on Success I CARE behaviors and skills. Ensure excellent customer service is provided to all patients/customers by seeking out opportunities to be of service.
Has access to all departmental files, memos, financial records and medical records, which are confidential. Must, adhere to all tribal, IHS, and CIHA confidentiality policies and procedures, as well as the Privacy Act of 1974 and the HIPAA regulations, in the performance of duties.
Mental /Visual /Physical
Concentration varies depending on the tasks. High levels of mental concentration are required. Must handle multiple tasks simultaneously and is subject to frequent interruptions. Physical effort requires sitting and reaching with hands and arms. Manual dexterity, visual acuity, and the ability to speak and hear are required.
Work is performed in normal business office environment, with occasional travel required.
Work under the general direction of the Business Office Supervisor. Has latitude for the exercise of initiatives, discretion, and independent judgment within the Cherokee Indian Hospital Authority.
Responsibility for Accuracy
Review of work and subsequent procedures would detect most significant errors of job functions. However, errors that are more serious could result in inefficient operations and loss of revenue and audit non-compliance.
Because information in the medical record is the basis for reimbursement as well as clinical decision-making, coding entries must be complete and accurate. The amount of reimbursement depends on the correct coding of diagnoses and procedures and appropriate DRG/APC assignment. The work has a direct effect on medical record keeping and a direct impact on the accuracy, documentation, timeliness, reliability, and acceptability of information in the medical record services.
Work has considerable impact on the accreditation status of the hospital, quality of patient care, reliability of research data, compliance and the maximization of Third-Party reimbursement.
Consistently demonstrates superior customer service skills to patients/customers by displaying various methodologies (ex. Spotlight on Success, I CARE, Heart Head Heart, etc.). Ensures excellent customer service is provided to all patients/customers by seeking out opportunities to be of service for subordinates. Consistently demonstrates superior customer service skills and acts as a positive role model for all employees. Communicates service problems, team plans, and facilitates problem-solving meetings with team. Immediately addresses service issues and follow up to ensure patient/customer satisfaction.