Surgery Reimbursement Specialist (1.0) at Franciscan Alliance, Inc.

Munster, Indiana, United States -

Full Time

Start Date

Immediate

Expiry Date

14 Feb, 26

Salary

0.0

Posted On

16 Nov, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Documentation, Communication, Nursing, Healthcare, Insurance Authorization, CPT Coding, Surgical Billing, Healthcare Finance, Reimbursement Processes, Denial Management, Process Improvement, Collaboration, Documentation Practices, Case Management, Patient Care, Surgical Procedures

Industry

Hospitals and Health Care

Description

Franciscan Health Munster Campus 701 Superior Ave Munster, Indiana 46321 The Clinical Document Specialist is responsible for improving the overall quality and completeness of clinical documentation. In this role you will facilitate modifications to clinical documentation through extensive concurrent interaction with physicians and coding staff to ensure that the record accurately reflects the diagnosis treated, procedures performed and the severity of illness of the patient. WHO WE ARE With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT Communicate with physicians, regarding missing, unclear or conflicting medical record documentation through the query process to clarify the information, obtain needed documentation, present opportunities, and educate for appropriate identification of severity of illness. Communicate with physicians, case managers, coders, and other healthcare team members to facilitate comprehensive medical record documentation ensuring they reflect clinical treatment, decisions, and diagnoses for inpatients. Utilize your expertise in understanding of complications, co-morbidities, the severity of illness, the risk of mortality, case mix, secondary diagnosis, and the impact of procedures on the final DRG; and share this knowledge to physicians and other members of the healthcare team. Identify patterns, trends, variances, and opportunities to improve the documentation review and process. QUALIFICATIONS Associate's Degree Nursing or Healthcare related field - Required Bachelor's Degree Nursing or Healthcare related field - Preferred Registered Nurse (RN) - State Licensing Board - Required Certified Clinical Documentation Specialist (CCDS) - Association of Clinical Documentation Integrity Specialists (ACDIS) - Preferred 7 years acute care nursing in lieu of Bachelor's Degree - Required 2 years Recent inpatient, case management, or ED - Required Experience assisting with insurance authorization approvals and payer follow-up - Required Skilled in validating surgical cases and verifying proper scheduling documentation - Required Strong understanding of CPT coding and surgical billing practices to ensure accurate reimbursement - Required Knowledge of healthcare finance, reimbursement processes, and denial management - Required Demonstrated ability to optimize financial outcomes through accurate coding and documentation practices - Required Proven ability to identify process improvements and support standardization of surgical procedures and supplies - Required Excellent communication skills and ability to collaborate effectively with nursing staff, physicians, and administrative teams - Required TRAVEL IS REQUIRED: Up to 20% EQUAL OPPORTUNITY EMPLOYER It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law. Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights. Franciscan Alliance is committed to equal employment opportunity. Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.

Responsibilities

The Surgery Reimbursement Specialist is responsible for improving the quality and completeness of clinical documentation. This role involves facilitating modifications to clinical documentation through interaction with physicians and coding staff to ensure accurate representation of diagnoses and procedures.