University Hospitals

Operations

• Provides virtual clinical care to patients within the recognized scope of practice for the profession and professional licensure requirements
• Provides clinical triage and clinical support using established protocols during in-bound and out-bound telephone communication with patients, family, caregivers and other members of the healthcare team
• Assists in coordination of incoming patient transfer requests with receiving facility and physicians
• Demonstrates technical skills in care delivery that result in safe practice and positive care outcomes
• Possess and obtain working knowledge of external and inter-facility protocols and standards of practice
• Demonstrates clear communication and effective collaboration to optimize patient care and clinical operations
• Delivering exceptional customer service while facilitating communication across multiple disciplines
• Work with all System Operations Center (SOC) staff in a team oriented, collaborative approach
• Responsible for promoting a Best Place to Work Culture and positive and professional work environment
• Actively participates in the development and implementation of performance/quality improvement

RN – System Operations Center

Clinical Research

• Overseeing study and regulatory operations including startup, maintenance and closeout for multiple multi-center, international clinical research studies
• Protocol compliance, regulatory documentation, quality control, data monitoring and reporting, Institutional Review Board (IRB) submissions
• Coordination of invoicing with administration and supervision of coordinator activities
• Provides support and database maintenance for ongoing research programs in database reviews and developing reports and tables documenting study status
• Manage and summarize study activities and data exports both internally for invoicing purposes and externally
• Maintain Standard Operating Procedures including SOP development, maintenance, tracking and implementation
• Oversee production and submission of invoicing backup documents to department administration for approval and invoice generation
• Maintain study-specific invoicing records
• Performs other duties as assigned.

Clinical Research Project Coordinator, Translational Science Unit

Medical Billing and Coding

• Responsible for accurately and timely coding of inpatient medical records following established coding, CMS regulations and hospital guidelines.
• Accurately codes diagnostic and procedural information following coding guidelines and regulations information including, facility specific guidelines and federal regulations.
• Reviews low to moderate complex medical records to assign diagnostic ICD-10-CM and or ICD-10-PCS codes according to established coding, CMS, and hospital guidelines (95%)
• Maintains productivity and quality rate according to established standards.
• Works within UH billing time frames.
• Maintains coding knowledge and skills via written coding resources, clinical information and educational webinars.
• Maintains knowledge of guidelines and regulations affecting the UHHS Coding Department.
• Maintains up to date credentials.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA).
• Abstracts selected data items and enters in 3M encoder/Epic software with accuracy and attention to detail.
• Follows facility query policy and CDI reconciliation process.
• Utilizes critical thinking/problem solving processes.
• Collaborates with and supports the Clinical Documentation Integrity Team.
• Demonstrates effective time management skills by completing assignments within time constraints and calendar schedule.
• Participates in educational and informational activities.
• Performs other duties as assigned.
• Complies with all policies and standards.

Inpatient Coding Specialist

Medical writer

• Ensures documentation is accurate and complete by performing timely medical record review and determination of code assignment by applying clinical and/or coding expertise to identify opportunities for improved or clarified documentation that accurately reflects the patient.
• Direct and timely follow-up with clinical providers to ensure requested clarification is provided.
• Responsible and accountable for expanding CDI and coding knowledge (keeping up to date on latest research, technology, treatment modalities, etc.)
• Utilizes critical thinking/problem solving processes.
• Appropriately utilizes and interprets professional association resource materials and regulatory agencies guidelines to enhance own skill sets: Coding Clinics, AHIMA, CMS guidelines.
• Identifies query opportunities for record integrity.
• Is proficient in query writing so that the question is easily understood by the physician.
• Escalates non-response to query by physicians immediately according to query escalation policy.
• Collaborates with the coding team.
• Actively engages in educating physicians and other clinical care providers regarding clinical documentation in a variety of formats including participation in clinical rounding, service line focused education sessions and one to one case specific feedback.
• Consistently provides a collaborative relationship with healthcare team providers/members.
• Provides ongoing service line directed education to provider teams.
• Applies knowledge of health care workflows in order to work collaboratively with medical staff and other health care team members to improve the overall accuracy and comprehensiveness of medical record documentation, with focus on ensuring accurate reporting of quality outcomes.
• Seeks and provides feedback for improved CDI practice and integrity/quality of medical record documentation.
• Meets established operational and productivity standards.
• Consistently meets productivity, quality, and AHIMA ethical standards.
• Proficient and efficient use of the CDI business platform.

Clinical Documentation Integrity Specialist

• Responsible for accurately and timely coding of moderately complex encounters following established coding, CMS regulations and hospital guidelines.
• Reviews moderately complex medical records to identify sequence, code diagnoses and procedures according to established coding, CMS and hospital guidelines.
• Responsible for accurately coding hospital same day surgery, observations, ancillary, ED encounters and/or professional services.
• Ensures optimal CPT, ASC, APC, APG assignment as applicable.
• Understanding and ability to resolve coding specific edits such as CCI, LCD, NCD, and MUE.
• Supports OP Clinical Documentation Improvement program.
• Maintains productivity and quality rate according to established standards.
• Works within UH Billing time frames.
• Maintains coding knowledge and skills via written coding resources, clinical information and educational webinars.
• Maintains knowledge of guidelines and regulations affecting the UHHS Coding Department.
• Maintains up to date credentials.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA).
• Participates in educational and informational activities as required.
• Performs other duties as assigned.
• Complies with all policies and standards.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients.

Outpatient Coding Specialist II

• Analyzes, on a daily basis and in accordance with established time frames, the outstanding insurance accounts
• Initiates appropriate and effective telephone and/or written follow-up on the identified accounts
• Communicates with payors and other internal departments as required to obtain critical information that impacts the resolution of both current and future claims
• Researches and responds to all telephone inquiries from the customer service department, in a prompt, professional manner meeting departmental guidelines
• Reviews and corrects coding edits and denials
• May code ICD-10 from written documentation
• May abstract CPT/HCPCS codes
• May perform computer assisted coding functions
• Consistently meets department productivity standards
• Consistently meets department quality standards
• Provides appropriate information and feedback to various personnel within UHPS
• Supports and utilizes established departmental guidelines
• Recommends additional research to other CBO departments
• Identifies trends with insurance related issues and reports findings to the Team Lead
• Acts as a role model for professionalism through appropriate conduct and demeanor at all times
• Interprets written correspondence and either resolves the problem or forwards it to another department for prompt resolution
• Effectively communicates utilizing the telephone, form letters or internal correspondence to resolve patient inquiries
• Handles multiple tasks simultaneously
• Must have an understanding of insurance products and billing requirements to effectively resolve discrepancies in billing statements
• Performs other related duties as assigned

Pro Fee Denials/Follow-Up Coder

• Monitors Coder Productivity
• Train, Audit, Code Surgical Encounters
• Be a resource for Physicians and other Departments
• Identifies trends with insurance related issues and reports findings to the Team.
• Analyzes outstanding insurance accounts
• Initiates appropriate and effective follow-up on identified accounts.
• Communicates with payors and other internal departments
• Researches and responds to all telephone inquiries from customer service
• Reviews and corrects coding rejections
• May code ICD-9 and E/M services
• Trains/mentors new coders
• Maintains patient/physician confidentiality
• Effectively communicates coding trends and documentation requirements
• Provides appropriate information and feedback to personnel within UHPS.