Provide implementation and subject matter expertise to create high performing revenue cycle for CHI:
- Implement and support the strategic plans, goals, and objectives for the CHI revenue cycle that promote leading practices.
- Support the revision to the standardized policies and procedures and institute changes to streamline operations and enhance revenue collections on an on-going basis, while remaining compliant with applicable regulations.
- Track and trend revenue cycle performance and participate in discussions for improvement as applicable
- Provide subject matter expertise across all components of the revenue cycle
- Support of revenue cycle partners to maximize performance.
HIS system optimization and maintenance
- Accurate and timely maintenance of Revenue Cycle system dictionaries and tables, based on collaboration with RRC management and IT resources when applicable
- Consults with Revenue Cycle leadership and process improvement teams to determine how best to address regulatory requirements, business changes, and improvement ideas.
- Review Revenue Cycle metrics, exception reports, and accounts receivable inventory for optimization an efficiency opportunities.
- Assist and lead work teams regarding optimization and corrections to the claim submission process. Translate business needs to claim and edits table structures changes.
- Track incidences and scheduled system changes in ITS ticketing systems.
- Works directly with the HIS vendor support staff on Revenue Cycle system issues/requests.
- Follow change control, pre-notification of change requirements, and approval processes when making system changes.
- Coordination of revenue cycle configuration changes into interfaced systems. Examples: clinical systems, middleware, proration calculations, and other revenue cycle partner systems.
Influence and collaboration with Teams
- Provide hands-on expertise to CHI Revenue Cycle and its partners.
- Improves team performance by providing feedback, initiating peer support, and assisting in obstacle avoidance
- Team with partners’ change leadership to proactively integrate change techniques
- Tracks quantitative and qualitative metrics tied to goals in order to meet objectives
- Reports progress and evaluates results on an ongoing basis.
Applied Knowledge
- Applies comprehensive knowledge of revenue cycle functions, market configurations, and system knowledge to refine and improve market performance.
- Studies industry best practice to bring insight and fresh perspective to CHI's approach to revenue cycle
- Partners with ITS to evaluate system upgrades and works with partners to effectively utilize new functionality available from the upgrade
- Adapt and comply with regulation changes. Work with partners to apply changes to the systems and procedures.
- Influence policy and procedures with technical knowledge & system capabilities. Support revisions to CHI’s formal Policy and Procedures.
Support the smooth transition of Revenue Cycle Management functions in CHI MBO acquisition and divestiture transactions as appropriate
- Represent the Revenue Cycle and provide input to stakeholders on the transition.
- Facilitate and perform assign responsibilities from the transition plan.
Benefits Include: Benefits include Medical, Dental, Vision, Paid Time Off, Holidays, Retirement Program, Disability Plans, Tuition Reimbursement, Adoption Assistance, Employee Assistance Program (EAP), Discount Programs, Life Insurance Plans, Worker Compensation, Dress for Your Day Policy, Voluntary Benefits.
Compensation Range: $ 29.02 to $37.73, hourly rates, annualized.
Franciscan Medical Group is currently looking for a full-time Revenue Cycle Rep for the Franciscan DME/Pharmacy Billing department in Tacoma. Five days a week and no weekends or major holidays required!
Job Summary:
This job is responsible for performing all related revenue cycle processing activities for Durable Medical Equipment (DME) and retail pharmacy in accordance with established standards, guidelines and requirements. An incumbent facilitates patient satisfaction through timely and accurate maintenance of patient accounts, including assistance with billing, third-party payments, adjustments, information verification and records maintenance. Work is heavily focused on following up on insurance rejections/denials and accounts receivable to maximize revenues. An incumbent responds to all information requests from payers and traces all claims to those payers making sure they have been paid or denied appropriately and in a timely manner.
Work also includes: 1) submitting claims to government agencies, medical service bureaus and insurance companies; 2) posting insurance and patient payments; 3) researching/resolving insurance and patient credit balances; 4) handling customer service calls and responding to patient queries; and 4) coordinating monthly DME equipment renewals.
Work requires an understanding of DME/pharmacy medical billing/reimbursement requirements, charge capture/cash posting/claims processes and government/commercial insurance reimbursement terms, remittance advice details and contractual/other adjustments. Attention to detail, the ability to accurately and timely troubleshoot/resolve (within position scope) issues that have a potential impact on revenues are also required.
Essential Duties:
Communicates with insurance payers regarding insurance rejections/denials and to resolve unpaid insurance accounts receivable; makes necessary corrections in the practice management system to ensure appropriate reimbursement is received for all FMG providers.
- Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
- Researches denials, gathering supporting documentation and drafting appeal letters explaining why denial should be reversed; resubmits claims with necessary information when requested through paper or electronic methods.
- Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.
- Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.
Submits claims to government agencies, medical service bureaus and insurance companies ensuring that accounts are billed appropriately by auditing charges to ensure accurate procedure codes, billing data and patient information submitted.
- Acts as a resource to physicians, providers, administrators and patients regarding health insurance claim policies, procedures and requirements; responds to inquiries from agencies, bureaus and insurance companies to assist in the claim payment process.
- Reviews claims for all necessary requirements for billing, including complete patient and insurance information; completes paper claim processing in a timely and accurate manner; submits claims to secondary insurers as appropriate.
- Notifies Supervisor of claim edits that could be reduced/eliminated through system modifications and/or communication and feedback to the department/clinic or other areas.
- Notifies Supervisor of additional claim edits that when added may reduce denials and result in prompt payment for the organization.
- Notifies Supervisor of claim submission requirement changes and electronic billing errors.
- Completes payer specific edits using knowledge of payer reimbursement methodologies or government regulations.
Serves as liaison between patients and clinic staff on claims, billing questions or insurance-related issues within scope of position.
- Provides feedback and in-service training to retail pharmacy and hospital staff with respect to billing/documentation requirements and restrictions on supplies and equipment.
- Accurately and timely posts private payments, insurance payments, disallows and/or denials to appropriate patient account,
- Calculates patient responsibility, interpret explanation of benefit message codes, identify payment discrepancies by contacting insurance carrier and determining if rebilling is necessary.
- Interprets and communicates information regarding credit policies and procedures, billing practices, insurance submission and out-of-pocket patient responsibility.
- Processes patient, clinic and insurance correspondence, including requests for refunds and collections when warranted.
Coordinates monthly renewals of all rental DME equipment.
- Monitors rental data to identify expiration dates based on established length of need dates; contacts patient prior to expiration date to confirm that equipment is no longer needed; faxes requests to physician for rental extensions as needed.
- Notifies departments to arrange for pickup of unneeded rental equipment.
Reviews and posts payments and write-off/adjustments from insurance and patients.
- Reviews Explanation of Benefits (EOBs)/ Electronic Remittance Advice (ERAs), payments, adjustments, insurance contracts and contracting system, insurance benefits, and all account comments; applies knowledge of payer contracts and experience with insurance reviews to gather additional information as necessary.
- Posts and tracks electronic funds transfer (EFT) information and validates EFTs for accuracy; ensures deposits balance to posting and resolves or escalates issues as appropriate.
- Follows write-off approval protocols for non-routine adjustments.
- Completes daily posting log and quarterly cash handling audits and reports findings to Supervisor.
- Completes accurate batch balancing and reporting activities; research errors, record adjustments to proper accounts and determine the appropriate destination for unidentified funds.
Identifies and researches unusual, complex or escalated issues as assigned; applies problem-solving and critical thinking skills as necessary to resolve issues within the scope of position authority or to escalate following established procedures.
- Notifies Supervisor/Manager of ongoing issues and concerns as appropriate.
Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records.
- Meets quality assurance and productivity standards for timely and accurate revenue cycle-related activities within position scope and in accordance with organizational policies and procedures.
- Accurately documents patient accounts of all actions taken in billing system.
Maintains current knowledge of internal, industry, and government regulations as applicable to assigned function.
- Has knowledge of, and is compliant with, government regulations including "signature on file" requirements, compliance program, HIPAA, etc.
- Applies current knowledge of current/revised regulatory requirements (e.g. Medicare/Medicaid) relating to the billing of durable medical equipment (e.g. orthotics, prosthetics and related products) and retail pharmacy medications.
- Understands detailed billing requirements, denial reason codes, and insurance follow-up practices; provides information regarding implementation of new codes and/or revision of charge documents as appropriate.
- Applies current knowledge of government/commercial insurance reimbursement terms, contractual and/or other adjustments and remittance advice details.
Performs related duties as required.
Expectations
- Collaborate with therapist, addiction therapist, and social workers to deliver high-quality patient care
- Monitoring patients’ conditions and assessing their needs
- Collaborating with physicians and nurses to devise individualized care plans for patients
- Administering patients’ medications and providing treatments according to physicians’ orders
- Fostering a supportive and compassionate environment to care for patients and their families
1. Patient Treatment
Provides quality care to patients and their families as instructed by a physician.
Provides and documents patient/family educational teachings as instructed by a physician, including patient/family understanding.
Accurately and thoroughly documents physician orders regarding patient phone, following clinic policies and procedures.
Provides appropriate care to patients in emergency situations as directed by a physician.
Performs routine clinic procedures as directed by a physician.
Administers medication accurately as directed by a physician.
2. Patient Assessment
Assist physician with patient exams and multiple clinic procedures, implements treatments and evaluations patient outcomes.
Accurately measures patient vital signs according to clinic policy and documents in patient chart for each office visit.
Maintains all medical equipment is in working condition.
Orders medical supplies appropriately maintaining wise use of the resources and cost containment.
Ensures that patient’s treatment procedures, medications and therapies are ordered, verified and have received patients consent. Evaluates and records outcomes as appropriate.
Assists in all areas of the clinic.
Assists patients with referral procedures, obtaining help with medications and other needed services.
3. Policies and Procedures
Has knowledge and adheres to all hospital and clinic policies that relate to individual’s job requirements.
Follows dress code of hospital and clinic.
Has good attendance record, is reliable in reporting to work.
Is punctual in reports to work on time
Completes CPR training prior to annual evaluation.
Adheres to all regulatory requirements for clinics. (OSHA, Infection Control, Fire and Safety)
Properly handles and disposes of needles/sharps and/or contaminated waste.
Follows exposure policy and treatment protocols according to Exposure Control Plan.
Practices proper safety precautions to avoid employee injury as evidenced by proper body mechanics, etc. (lifting patients).
4. Information Management
Participates in monthly staff meetings. Reads and signs minutes of unattended meetings. Offers positive and constructive remarks during the meeting.
Communicates with patient and their insurance company, to obtain referral and authorization information.
Obtains referrals using appropriate provider list and provides referral information to both the patient and the referral specialist.
Provides and documents patient/family educational teaching as instructed by a physician, including patient/family understanding.
Accurately and completely documents physician orders regarding patient phone calls.
Complete and concise documentation of patient emergency situation is recorded in patient’s chart.
Follows clinic guidelines regarding chart documentation.
5. Communication/ Education
Uses tack, courtesy, sound judgment and a professional attitude when relating to patients, families, and co-workers.
Maintains patient confidentiality
Demonstrates willingness to be flexible.
Researches patient problems and effectively provides solutions.
Serves as preceptor, providing an opportunity for new employees to learn the clinical procedures and clerical responsibilities necessary to perform their job responsibilities.
6. Stewardship
Is honest in using hospital and clinic resources.
Uses time wisely in completing job assignments.
Your time at work should be fulfilling. Rewarding. Inspiring. That’s what you’ll find when you join one of our non-profit CHI facilities across the nation. You’ll find challenging, rewarding work every day alongside people who have as much compassion as you. Join us and together we’ll create healthier, stronger communities. Imagine your career at Catholic Health Initiatives!
Job Responsibilities
As a Registered Nurse, you will be responsible for delivering the highest quality patient care according to the specific orders of each patient’s individual physician. This will involve, utilizing your knowledge and skills to educate patients and their families on prevention and healthy habits.
Additional responsibilities for this health care role include:
- Monitoring patients’ conditions and assessing their needs
- Collaborating with physicians and nurses to devise individualized care plans for patients
- Administering patients’ medications and providing treatments according to physicians’ orders
- Fostering a supportive and compassionate environment to care for patients and their families
Additional responsibilities for this health care role include:
· Studying patients' medical history, test results, and treatment plans.
· Tracking routine heart rate, blood pressure, and pulse oximetry measurements.
· Monitoring, interpreting, and recording data from specialized medical technologies and equipment.
· Administering medication and performing treatment interventions in consultation with healthcare specialists.
· Maintaining and updating ward charts, patient files, and medical records.
· Instructing Telemetry Unit staff on patient care and treatment plans.
· Collaborating with healthcare specialists and reporting changes and deteriorating conditions.
· Explaining tests results and procedures to patients and their families, as well as answering questions.
· Advising patients on post-hospital care, including prescribed medicine, home care protocols, disease prevention, and lifestyle changes.
Additional responsibilities for this health care role include:
· Studying patients' medical history, test results, and treatment plans.
· Tracking routine heart rate, blood pressure, and pulse oximetry measurements.
· Monitoring, interpreting, and recording data from specialized medical technologies and equipment.
· Administering medication and performing treatment interventions in consultation with healthcare specialists.
· Maintaining and updating ward charts, patient files, and medical records.
· Instructing Telemetry Unit staff on patient care and treatment plans.
· Collaborating with healthcare specialists and reporting changes and deteriorating conditions.
· Explaining tests results and procedures to patients and their families, as well as answering questions.
· Advising patients on post-hospital care, including prescribed medicine, home care protocols, disease prevention, and lifestyle changes.
Additional responsibilities for this health care role include:
· Studying patients' medical history, test results, and treatment plans.
· Tracking routine heart rate, blood pressure, and pulse oximetry measurements.
· Monitoring, interpreting, and recording data from specialized medical technologies and equipment.
· Administering medication and performing treatment interventions in consultation with healthcare specialists.
· Maintaining and updating ward charts, patient files, and medical records.
· Instructing Telemetry Unit staff on patient care and treatment plans.
· Collaborating with healthcare specialists and reporting changes and deteriorating conditions.
· Explaining tests results and procedures to patients and their families, as well as answering questions.
· Advising patients on post-hospital care, including prescribed medicine, home care protocols, disease prevention, and lifestyle changes.
Our comprehensive, 12-month program provides recent graduates of nursing schools with a consistent and thorough orientation experience designed to successfully transition them into professional practice.
During the orientation phase of the program, residents:
- Gain access to key systems
- Complete orientation checklists
- Participate in simulations
- Complete patient care with an experienced preceptor
Further develop critical thinking skills and increase their confidence in providing safe patient care
New nurses begin their training in July 2021. Education and training are unique to the clinical track.
Our comprehensive, 12-month program provides recent graduates of nursing schools with a consistent and thorough orientation experience designed to successfully transition them into professional practice.
During the orientation phase of the program, residents:
- Gain access to key systems
- Complete orientation checklists
- Participate in simulations
- Complete patient care with an experienced preceptor
Further develop critical thinking skills and increase their confidence in providing safe patient care
New nurses begin their training in July 2021. Education and training are unique to the clinical track.
GENERAL SUMMARY:
Provides individualized, high-quality nursing care to patients of all ages. Uses a team approach to delegate and coordinate patient care at admission, transfer, and discharge. Independently delivers nursing care using the Nurse Practice Act, Mercy Medical Center policies, nursing standards, ethical principles, and professional judgment. Works rotating shifts, weekends, and holidays as scheduled.
ESSENTIAL FUNCTIONS:
- Assesses, plans, and implements nursing care while ensuring patient comfort.
- Practices safe patient handling techniques.
- Continues to evaluate assigned patients and provides ongoing treatment.
- Anticipates, identifies, and responds to educational and emotional needs of patients and families.
- Guides and directs healthcare personnel (i.e. Patient Care Technicians) in caring for patients.
- Maintains knowledge of equipment set-up, maintenance, and use (i.e., IV pumps, monitoring equipment, and drainage devices). Utilizes safeguards such as IV pump drug library and monitor alarms whenever available to maximize patient safety.
- Initiates emergency support measures (i.e., cardiopulmonary resuscitation, protecting patient from injury).
MARGINAL FUNCTIONS:
- Serves in a charge/leadership role based on skill and unit needs. When assigned charge, makes patient assignments; triages patients; and problem solves with staff, physicians, patients, families, and ancillary departments.
- Takes assigned call as defined in unit policy.
- Assists with patient care duties/tasks (i.e., emptying drainage devices, ambulating, and hygiene).
- Assists with clerical duties (i.e., maintenance of chart, patient record, and answering phones and call lights).
- Maintains patient care supplies, equipment, and environment.
- Provides orientation/education for staff, students, and other hospital and community organizations as requested.
DISCLOSURE STATEMENT:
The above statements reflect the general details considered necessary to describe the essential functions of the job as identified but should not be considered a detailed description of all work requirements that may be needed to perform the duties of this position. Must have ability to maintain skills and perform tasks required for the position as outlined in the list of department competencies.
Our comprehensive, 12-month program provides recent graduates of nursing schools with a consistent and thorough orientation experience designed to successfully transition them into professional practice.
During the orientation phase of the program, residents:
- Gain access to key systems
- Complete orientation checklists
- Participate in simulations
- Complete patient care with an experienced preceptor
Further develop critical thinking skills and increase their confidence in providing safe patient care
New nurses begin their training in July 2021. Education and training are unique to the clinical track.
Provides nursing care according to the nursing process, including assessment, diagnosis, planning, implementing and evaluating. Implements appropriate nursing care interventions. Administers medications and treatments in accordance with physician orders and established nursing policies and procedures. Care provided is based on defined standards of patient care and nursing evidence-based practice.
Essential Key Job Responsibilities
- Assumes responsibility for acquiring knowledge and skills necessary for patient care in the identified practice setting.
- Performs assessment and analyzes patient problems and conditions using critical decisioning to determine need for standard, urgent or emergent interventions.
- Implements and/or modifies plan of care using assessment data, standards of care and evidence based practice inclusive of nursing care coordination, appropriate patient and family education, and discharge planning. Facilitates interdisciplinary partnership in patient care.
- Integrates ethical provisions in nursing practice and delivers care in a manner that preserves and protects patient autonomy, dignity and rights.
- Administers medications, IV therapy, and treatments in compliance with policies and procedures.
- Evaluates progress towards attainment of desired patient outcomes.
- Demonstrates effective on-going observations and reassessment of patient/family and their response to the interventions and changes in condition.
- Documents assessments and interventions in accordance with hospital policy and standards of care.
- Utilizes resources appropriately and follows facility guidelines for documentation and charging of medical supplies and equipment.
- Assigns or delegates tasks to designated support personnel based on needs and conditions of the patient, complexity of the task, predictability of the outcome and facility policy.
- Collaborates with new employees and peers to support orientation, training and development opportunities. Supports the profession of nursing through support for nursing student clinical activities, as appropriate.
- Other duties as assigned.
The Cath Lab RN will play an important role in the direction and quality of patient care in the Cath Lab. Strong experience with the technology and techniques of Cardiac Catheterization is required, as is knowledge of Cath Unit Operations and Standards of Practice. Primary among your responsibilities will be scrubbing and circulating various patient cases, but you’ll also get valuable experience in maintaining lab supplies and inventory, contributing to quality improvement processes, and having a distinguished voice in nursing operations.
Expectations
- Monitoring patients’ conditions and assessing their needs in the cath lab
- Collaborating with physicians and nurses to devise individualized care plans for patients
- Administering patients’ medications and providing treatments according to physicians’ orders
- Fostering a supportive and compassionate environment to care for patients and their families
JOB SUMMARY / PURPOSE
Provides nursing care according to the nursing process, including assessment, diagnosis, planning, implementing and evaluating. Implements appropriate nursing care interventions. Administers medications and treatments in accordance with physician orders and established nursing policies and procedures. Care provided is based on defined standards of patient care and nursing evidence-based practice.
ESSENTIAL KEY JOB RESPONSIBILITIES
1. Assumes responsibility for acquiring knowledge and skills necessary for patient care in the identified practice setting.
2. Performs assessment and analyzes patient problems and conditions using critical decisioning to determine need for standard, urgent or emergent interventions.
3. Implements and/or modifies plan of care using assessment data, standards of care and evidence based practice inclusive of nursing care coordination, appropriate patient and family education, and discharge planning. Facilitates interdisciplinary partnership in patient care.
4. Integrates ethical provisions in nursing practice and delivers care in a manner that preserves and protects patient autonomy, dignity and rights.
5. Administers medications, IV therapy, and treatments in compliance with policies and procedures.
6. Evaluates progress towards attainment of desired patient outcomes.
7. Demonstrates effective on-going observations and reassessment of patient/family and their response to the interventions and changes in condition.
8. Documents assessments and interventions in accordance with hospital policy and standards of care.
9. Utilizes resources appropriately and follows facility guidelines for documentation and charging of medical supplies and equipment.
10. Assigns or delegates tasks to designated support personnel based on needs and conditions of the patient, complexity of the task, predictability of the outcome and facility policy.
11. Collaborates with new employees and peers to support orientation, training and development opportunities. Supports the profession of nursing through support for nursing student clinical activities, as appropriate.
12. Other duties as assigned by management.
Our comprehensive, 12-month program provides recent graduates of nursing schools with a consistent and thorough orientation experience designed to successfully transition them into professional practice.
During the orientation phase of the program, residents:
- Gain access to key systems
- Complete orientation checklists
- Participate in simulations
- Complete patient care with an experienced preceptor
Further develop critical thinking skills and increase their confidence in providing safe patient care
New nurses begin their training in July 2021. Education and training are unique to the clinical track.
JOB SUMMARY / PURPOSE
Provides nursing care according to the nursing process, including assessment, diagnosis, planning, implementing and evaluating. Implements appropriate nursing care interventions. Administers medications and treatments in accordance with physician orders and established nursing policies and procedures. Care provided is based on defined standards of patient care and nursing evidence-based practice.
ESSENTIAL KEY JOB RESPONSIBILITIES
1. Assumes responsibility for acquiring knowledge and skills necessary for patient care in the identified practice setting.
2. Performs assessment and analyzes patient problems and conditions using critical decisioning to determine need for standard, urgent or emergent interventions.
3. Implements and/or modifies plan of care using assessment data, standards of care and evidence based practice inclusive of nursing care coordination, appropriate patient and family education, and discharge planning. Facilitates interdisciplinary partnership in patient care.
4. Integrates ethical provisions in nursing practice and delivers care in a manner that preserves and protects patient autonomy, dignity and rights.
5. Administers medications, IV therapy, and treatments in compliance with policies and procedures.
6. Evaluates progress towards attainment of desired patient outcomes.
7. Demonstrates effective on-going observations and reassessment of patient/family and their response to the interventions and changes in condition.
8. Documents assessments and interventions in accordance with hospital policy and standards of care.
9. Utilizes resources appropriately and follows facility guidelines for documentation and charging of medical supplies and equipment.
10. Assigns or delegates tasks to designated support personnel based on needs and conditions of the patient, complexity of the task, predictability of the outcome and facility policy.
11. Collaborates with new employees and peers to support orientation, training and development opportunities. Supports the profession of nursing through support for nursing student clinical activities, as appropriate.
12. Other duties as assigned by management.
Expectations:
- Ability to multitask in a fast paced environment while delivering quality patient care
- Collect, read, and interpret assigned patient’s health history
- Create and implement care plans in collaboration with other care team members
- Administer medications to patients and educate caregivers when necessary
Expectations:
- Ability to multitask in a fast paced environment while delivering quality patient care
- Collect, read, and interpret assigned patient’s health history
- Create and implement care plans in collaboration with other care team members
- Administer medications to patients and educate caregivers when necessary
Expectations:
- Ability to multitask in a fast paced environment while delivering quality patient care
- Collect, read, and interpret assigned patient’s health history
- Create and implement care plans in collaboration with other care team members
- Administer medications to patients and educate caregivers when necessary
