Hours:

Shift Start Time:

Variable

Shift End Time:

Variable

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

As Needed

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$24.587 - $30.733 - $36.880

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do
Obtains and verifies patient demographic, visit, and financial information in a manner that facilitates departmental efficiencies, maximum financial reimbursement, and promotes premier customer service. This position will place patients via computer to assigned medical, surgical, cardiac, and critical care beds according to the Bed Protocol. Bed assignment will be communicated to the receiving and transferring floors/departments via computer system and telephone system. In an effort to provide complete customer satisfaction, this position should accurately listen and respond appropriately to requests from physicians, inter-departments, and peers. To ensure patients are assigned rooms in an expedient manner, this position will utilize all critical resources within the organization to expedite this process. This position must ensure all paperwork and computer entry is checked for accuracy and will continually enhance their knowledge regarding processes. This position should give high priority to customer service and complete customer satisfaction. This position will coordinate the successful transfer and placement of patients within the organization. This position must be able to adjust through a rapidly changing environment. This position will participate in personal and professional growth, development, and continuous improvement in all critical success factors of people, service, quality, financial, and growth. This position will be required to work weekends, and holidays.

Required Qualifications

• 5 Years Hospital revenue cycle experience to include: admitting, pre billing, pre verification, or accounts receivable follow up

Preferred Qualifications

• H.S. Diploma or Equivalent
• Local, State, and Federal regulations governing registration/billing activities including JCAHO, Title XXII, Medicare and Medi-Cal regulations. ICD-9, and CPT 4 coding experience
• Certified Revenue Cycle Representative (CRCR) - HFMA -PREFERRED

Essential Functions

• Billing
  Completes all functions required to process billing of all hospital visits by producing a prompt, clean bill drop 4-7 days post patient discharge. All billings comply with Federal, State and local billing guidelines and criteria without exception. Participate in the achievement of team billing goals through timely release of billable accounts and release of series bills.
  Functions include:
  Completes accurate demographic data, including validation or insurance benefits for each admission.
  Completes accurate visit data including updating accurate attending physician, diagnosis and patient location.
  Validates accurate orders in Cerner to ensure appropriate patient type and accommodation codes are selected.
  Complete and accurate insurance selection to include the competition of follow-up questions, notifications are made to payors within 24 hours.
  Insurance/physician notification – documented accurately in patient visit and updated in insurance follow up questions.
  Signatures: COA, CMRI letter, financial waiver, denial letters updating registration fields to ensure alerts are triggered on account to ensure that rep on site will follow up with patient.
  Medical record numbers are not duplicated.
  Ensures there are no PHI breeches Screens accounts and make appropriate referrals to FC or On site staff for follow up on unfunded patients.
  Screens all Medicare inpatient admissions for 72-hour outpatient overlap.
  72-hour outpatient overlaps are used for Medicare inpatient admits.
  Complies with all rules and regulations governing Medicare and Medi-Cal billing.
  Any additional functions as described in Department memos or general updates, including assisting with pre-billing functions as assigned.
  Obtains all necessary attachments required for billing (i.e. hard copy authorizations, medical records. 18-1. 50-1. etc.).
  Assures billing compliance standards are met.
  Checks for Medicare eligibility, MVP or insurance website for validate insurance coverage.
  Reviews and release all necessary hold bills.
  Scheduled, Direct admit patients are pre-verified and pre-authorized prior to hospital admission.
  Urgent admissions are verified and authorized immediately or upon next business day.
  Works Hold Bills at the end of reach admission process to ensure all holds are released appropriately to support the low touch billing process of the revenue system.
  MEASUREMENT: Random sample audits reflect a 93-97% accuracy rate. Avoidable duplicate medical record numbers are not created. Coached errors are not repeated. 2-3 exceptions per year meet standard.
• Complies with all Local, State and Federal guidelines
  Complies with all Local, State and Federal guidelines governing Department operations as well as all SDHA and Department memos, guidelines, policies and procedures.
  Takes responsibility for policy and procedure knowledge.
  Accesses department references accordingly to assure compliance
  MEASUREMENT: Knowledge of identification of non-compliance reported to management immediately. No formal corrective action meets standard.
• Customer service
  Receives and resolves incoming calls and instant notifications for the Centralized Patient Placement Center Department reflecting the Mission, Values and Philosophy of Sharp HealthCare.
  Demonstrates exemplary customer service and conducts calls using scripting.
  Accurately documents the patient's visit in appropriate computer systems for all pertinent facts, information and resolutions.
  Consistently follows all HIPAA requirements.
  Demonstrates overall system knowledge by accurate use of computer systems.
  Demonstrates a positive, caring attitude to all customers by providing prompt, courteous, and competent assistance in both personal and telephone interactions.
  Greets all customers in a cheerful helpful, professional manner.
  Strives to assure customer satisfaction with every encounter.
  Assures proper handling of all written correspondence, physician orders, and/or electronic mail.
  When appropriate, customer concerns, requests, billing questions or general inquiries are addressed or resolved personally, and not forwarded to leadership.
  Management is advised of all unusual, significant encounters.
  Communicates regularly to the nursing units of prospective admissions
  Communicates effectively and professionally with the on-call physicians, Emergency room physicians and Case Managers when appropriate
  MEASUREMENT: No more than 2-3 valid observed or documented exceptions per year meets & exceeds standard.
• Department production
  Contributes proportionately to Department production. Offers to assist others and asks for assistance in completion of assignments, as needed. Prioritizes effectively, keeps management informed of backlogs and promotes a team approach in completion of job duties. Downtime is used productively.
  Monitor all visits in TeleTracking for timely placement and accurate assignment of insurance and accommodation type. Contact hospital departments such as Medical Records, Utilization Review, pre billing, financial counselors or external review organizations to resolve any billing or authorization delays. Provide Team Leader and or manager with any account issues that were unresolved.
  Accurately follows department guidelines, policies and procedures regarding patient placement, order validation and insurance verification.
  Ensures that patients move efficiently through the systems appropriately and timely collaborates with physicians, case managers and bed coordinators to ensure timely placement.
  Ensures all notifications are completed on each shift worked and if unable to complete it’s communicated to the next shift
  MEASUREMENT: 3 expectations of Notifications not sent to payors or lack of follow up on a financial clearance will meet standard.
• Problem solving
  Demonstrates efficiency, organizational and multitasking skills.
  Must have the ability to work in a fast-paced environment with a positive attitude toward all professional contacts.
  Must have the ability to use multi-line telephones and view multiple screens with multiple applications running.
  Coordinates with other Patient access service departments, surgery, emergency, nursing units,  and physicians to facilitate efficient bed placement.
  Critical thinking skills.
  Conflict resolution - seeks appropriate win/win solutions.
  Must possess a positive attitude toward healthcare members and a diverse patient population.
  Exhibits diplomacy, time management, and conflict resolution skills.
  Demonstrates leadership skills.
  Must possess outstanding verbal, non-verbal, and written communication skills.
  Must possess a positive, caring, respectful, calm attitude.
  Demonstrates ability to initiate, accept and adapt to change, flexibility.
  Must possess superior listening and negotiating skills and be able to handle situations with confidentiality, trust, and finesse.
  MEASUREMENT: Leadership intervention for more than 3 instances of not demonstrating problem/critical thinking skills, will meet standard.
• Professional development
  Accepts instruction, coaching and counseling in a positive productive manner. Identifies own need for skill development and pursues training opportunities.
  Proficient in use of computers; Word and Excel skills preferred
  MEASUREMENT: Feedback is accepted constructively and a participative action plan is created when necessary to meet standard.
• Teamwork
  Demonstrates teamwork and cooperation through positive and supportive communication regarding Department changes, goals, policies and procedures. Promotes a positive work environment by respecting others, being honest, fair, and consistent. Takes responsibility for Department morale, and involves management accordingly when issues that affect morale arise.
  Asks necessary questions regarding new ideas or changes to facilitate a positive reaction and support for innovation. Brings an uplifting, positive approach to work assignments. Accepts interpersonal differences and cooperates with other employees.
  Accepts responsibility for own actions, personal growth, and development. Attends and participates in regularly scheduled staff meetings and training.
  Assists team members with outstanding insurance notification and verifications related to patients that are being placed or transferred.
  MEASUREMENT: Supervisor observations, monitoring of random patient visits will show that department policy without valid supporting documentation on account. 2-3 exceptions per year will meet standard. No more than 5-6 exceptions for meeting attendance per year meets standard.

Knowledge, Skills, and Abilities

• Medical terminology.
• Insurances, billing and collections guideline/criteria.
• Basic computer application experience, Centricity/ ADT,HPA, Cerner, On base, ECIN, Tele tracking, Transfer Center preferred.
• Continuous use of computer, including reading and data entry, up to 90% of the shift.
• Maintain an accurate typing speed of 35-40 wpm.
• Organized and prioritize work activities.
• Ability to communicate/discuss personal and financial matters with other healthcare workers i.e. physicians and nursing staff.
• Document effectively and concisely.
• Communicate effectively both verbally and in writing.
• Function well in demanding/stressful environments.
• Basic utilization management.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

Certified Revenue Cycle Representative (CRCR) - HFMA; H.S. Diploma or Equivalent