Account Research Specialist, Remote

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

The Account Research Specialist prospectively validates procedure code assignment in accordance with AHA ICD-10-CM and AMA CPT-4 coding conventions, UHDDS guidelines and CMS directives. Researches failed claims, identifies discrepancies and communicates resolution to appropriate departments.

Job Duties And Responsibilities

• Conducts reviews of cases lost with feedback to respective departments
• Prospectively validates OR procedure code assignment for HIM, OR and/or general surgery cases according to AMA CPT-4 coding conventions utilizing EPIC and/or other OR applications as appropriate
• Responsible for remaining up-to-date with knowledge of AHA ICD-10-CM and AMA CPT-4 coding conventions and guidelines. Maintains a working knowledge of prospective payment systems as it relates directly to coding process
• Ensures that appropriate IP patient class is obtained for IP only Medicare cases prior to date of service
• Identifies potential patient class mismatches based on planned OR Surgical CPT-4 assignment
• Follows up with case management for post op cases that were flagged as potential status issues to ensure accurate patient status prior to discharge
• Assists with outstanding HIM DNB/Claim edit work queues researching outstanding inpatient and/or outpatient accounts for resolution. Research may include, but is not limited to, missing documentation, outstanding OR dictations, incorrect and/or missing charges, incorrect CPT code assignment, and/or physician queries
• Serves as liaison between Physician Advisor/Medical Director, Finance, Case Management and CDCI

Physical And Sensory Demands

Sitting for up to 7 hours per day, 3 hours at a time. Repetitive arm/finger use retrieving/viewing computerized patient medical record and abstracting of patient information. Extended periods of vision use for reviewing computerized patient records, abstracting of patient information, approximately 7 hours per day, 3 hours at a time. Hearing as it relates to normal conversation. Occasionally may be required to use upper extremities to lift up to 10 lbs.; stoop, bend, or reach to retrieve resource materials and/or paper records in accordance with department downtime policy.

Education

High school diploma or equivalent required. RHIA, RHIT, CCS and/or CPC strongly preferred.

Training And Experience

Prior experience in account research will be considered.

HOURS: Mon-Fri, 8 AM - 4 PM, Remote for local (PA, NJ) candidates.

Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!

Hiring Company is an Equal Opportunity Employer.

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