Vail Health

Customer Support

• Resolve patient and insurance issues through taking phone calls, answering voicemails, taking action on all correspondence, and working with walk-in patients.
• Manages daily call traffic flow and makes adjustments to phone coverage based on call traffic patterns to ensure 95% of calls presented to individual Customer Service Representative and Customer Service Call Center queue are handled.
• Provides training and support to all Customer Service Specialist Representatives with oversight from PFS Management.
• Verify patient account balances, take payments and applies payments and adjustments to patient accounts in the various computer systems.
• Triage then communicate and collaborate with team members for account resolution.
• May be required to process mail and patient refunds, as well as perform cash posting, billing, and patient follow-up.
• Monitors and provides data to Management regarding quality and productivity of Customer Service Specialist calls for quality and training purposes.

Lead Customer Service Specialist

Auditor

• This position audits the activities of the Coding Specialists and Providers to ensure accurate coding that achieves organizational quality and financial expectations.
• Works with the Coding Manager to plan work, organize resources, motivate, and monitor staff performance through quality audits.
• Reads patient records in accordance with Governmental, third-party payer, and facility rules and regulations, accurately assigns and sequences ICD-10-CM diagnosis, ICD-10-PCS procedural codes and/or CPT E&M and procedural codes to inpatient and outpatient records for use in reimbursement and data collection.
• Conducts monthly reviews of coding quality by auditing pre and post bill records for coding compliance and records quality for each coder.
• Reviews findings with the individual coding specialists and, when appropriate, provides education to address deficiencies.
• Tracks and reports findings to the Coding Manager.
• Conducts quarterly reviews of coding quality and records quality for each assigned provider.
• Reviews findings with the individual providers or provider groups and, when appropriate, provides education to address deficiencies.
• Competently performs all duties of a Coding Specialist III.
• Collaborates with others in the organization including Medical Staff, other clinicians, and physician office staffs; and with Patient Financial Services to ensure the codes submitted for claims are supported by the documentation in the record.
• Participates in various hospital/physician committees as appropriate and prepares and provides provider in-services.
• Attends all required in-services and coder meetings. Identifies and attends training and educational programs conducive to professional growth.
• Supports the philosophy, objectives, and goals of the organization and department by volunteering in various capacities without compromising performance expectations.

HIM Coding Auditor

Medical Billing and Coding

• Assign appropriate codes for all patient types and provider clinics, including consulting with physicians and clinical staff for appropriate coding of difficult cases and code assignments.
• Verifies patient information to identify any documentation vs. report discrepancies and ensures codes and other abstracted data are accurately applied to appropriate patient’s account/encounter.
• Primarily codes outpatient encounters. Applies codes to conditions and procedures documented in the medical records to provide information for financial reimbursement and data collection, converts interpreted data into appropriate code numbers.
• Recognizes and reports unusual circumstances and/or information with possible risk factors to appropriate risk management and HIM Manager. Reports problems, errors, and discrepancies in dictation and patient records to HIM Manager. While reviewing the record for coding purposes, serves as quality reviewer of scanned documents. Identifies mis-scans and poorly scanned documents and reports them to HIM Director.
• Meets coding quality and quantity expectations of 95% or higher.
• Collaborates with others in the organization including the Quality Department, Medical Staff, other clinicians, and physician office staffs; and with Patient Financial Services to ensure the codes submitted for claims are supported by the documentation in the record.
• Excellent written and oral communication skills and the ability to work independently with minimal supervision required. Legible penmanship required.
• Attends all required in-services and coder meetings. Identifies and attends training and educational programs conducive to professional growth. Utilizes current literature and workshops attended to the benefit of Vail Health. New ideas, policies, regulations, and philosophies are adapted to current policies and procedures appropriately.
• Supports the philosophy, objectives, and goals of VH and the HIM department by volunteering in various capacities without compromising performance expectations. Role models the principles of a Just Culture and VH Values.
• Contributes to the efficiency of the HIM department. Routinely volunteers to assist others when their work is completed.
• Routinely abides by standards of professional and ethical conduct as defined by CMS, AHIMA, and the professional organization from which the incumbent is certified and/or credentialed.
• Understands and complies with policies and procedures related to medicolegal matters including confidentiality, amendment of medical records, release of information, patient rights, medical records as legal evidence, informed consent, etc. Is knowledgeable of and complies with Vail Health HIPAA, Safety and Compliance Program Policies and Procedures.
• Perform other duties as assigned.

HIM Coding Specialist – PRN

Manager

• Oversee day-to-day operations of the Business Operations teams for billing, account payment posting, insurance account follow-up, and account reconciliation.
• Resolve high-level issues for practice management systems, patient statements, and outstanding insurance balances.
• Monitors Key performance indicators as assigned.
• Collaborate with Patient Access and Scheduling staff to ensure best practices for maximum revenue capture being followed.
• Hiring, training, supervision, oversight, and management of assigned direct reports.
• Provides feedback to staff on assigned KPIs and department performance.
• Escalates issues, keeping the director/VP aware of areas of concern and when KPI's fall short.
• Maintains an area of responsibility within the surgery center annual budget.
• Stay informed of regulatory and compliance guidelines.
• Maintain and communicate thorough knowledge of the payer contracts.
• Comprehensive knowledge of the patient accounting systems with interfaces to claims clearinghouse.
• Plan, prioritize and delegate work tasks to ensure the proper functioning of the assigned areas within the department.
• Write, implement, and ensure adherence to policy and procedures within the department.
• Collaborate with the department’s Director/VP in implementation of new processes, identifying continuous process improvement opportunities.
• Provides a comprehensive training program to areas of responsibility to ensure consistent and thorough training.

Manager – Revenue Cycle

• Oversee day-to-day operations of the Patient Accounts teams.
• Resolve high-level issues for systems, patients, and vendors.
• Identify and continuously improve patient account processes and integrate them into the hospital system.
• Provides for selection, training, supervision and other personnel matters within the patient accounts department in accordance with approved staff budget and hospital policies. Ensure adequate staffing and cross training in department to meet the needs of the organization.
• Maintain thorough knowledge of all contracts and ensure compliance of both the facility and third party payers.
• Write, implement, and ensure adherence to policy and procedures within department, communicating with other departments as necessary and meeting JCACHO guidelines.
• Act as Super User to Vail Health and Clinics for all patient accounting specific programs as necessary.
• Build and Maintain electronic and/or paper training library for Patient Accounts, including developing, implementing, and maintaining training programs.

Lead Customer Service Specialist

HIM Coding Auditor

HIM Coding Specialist – PRN

Manager – Revenue Cycle

Manager – Business Office