REIMBURSEMENT SPECIALIST

Scripps is a not-for-profit, community-based health care delivery network in San Diego, California, that includes five acute-care hospitals, more than 2,600 affiliated physicians, an extensive ambulatory care network, home health care and associated support services. As a result of the July 2000 reaffiliation with Scripps Clinic, Scripps now has approximately 10,000 employees and also cares for patients at 12 Scripps Clinic locations throughout San Diego County.Division: Scripps HospitalsDepartment: HEALTH INFORMATIONJob Type: Full-TimeShift Type: DaysShift Hours: 8 Hr ShiftPosition Profile: The Cardiovascular Reimbursement Specialist performs accurate assignment of diagnostic & procedural codes for all cases performed in the assigned Clinical Area (CardioVascular Lab). Works as a team member with the clinical personnel & physicians to ensure optimal reimbursement for the hospital. Verifies level of care for all cases. Abstract information from records & keys information into the various computer systems. Performs audits of medical records against the itemized bill & also performs special audit requests. Ensures that all charges related to procedure performed in the clinical area are entered into the patient accounting system. Coordinates & reports audit outcome regarding charge errors, percentage of savings or losses for Scripps' facilities, data processing errors, and the performance of hospital charging system, documentation and justification with the medical record & itemized bill.
As a team member, the Reimbursement Specialist plays an important role by working in an integrated model collaborating with the HIMS Department, Clinical Areas at the Mercy SD/CV compuses contributing toward our mission and values.SCRIPPS VALUESWe provide the highest quality of service.Scripps is committed to putting the patient first and quality is our passion. In the new world of health care, we want to anticipate the causes of illness and encourage health behavior for all who rely on us for service. We teach and encourage patients to participate in their care and to make well-informed decisions. We will be their advocate when they are most vulnerable. We measure our success by our patients’ satisfaction, their return to health and well-being, and our compassionate care for dying patients, their families ad friends.We demonstrate complete respect for the rights of every individual.Scripps honors the dignity of all persons, and we show this by our actions toward one another and those we serve. We embrace the diversity that allows us to draw on the talents of one another. We respect and honor the cultural, ethnic and religious beliefs and practices of our patients in a manner consistent with the highest standards of care. All this is done in a compassionate setting. Our goal is to create a healing environment in partnership with all caregivers who are committed to serving our patients.We care for our patients every day in a responsible and efficient manner.Scripps serves as a major community health care resource for San Diego County and, as such, we are accountable for the human, financial and ecological resources entrusted to our care as we promote healing and wholeness. We begin from a base of excellence and collaborate with co-workers, physicians, patients, and other providers to find new and creative ways to improve the delivery of health care services. All members of our community will have access to timely, affordable and appropriate care.
REQUIREMENTS
Preferred Qualifications: Exp/Specialized Skills: Demonstrates proficiency in use of ICD9CM & CPT assignments through written exam. Understands insurance terms. Previous hospital or ambulatory surgery coding required. Two to four year degree, (or equivalent experience) in healthcare related field preferred. Experience with PC's, word-processing, spreadsheets, graphics and database software applications is desired. Previous auditing experience preferred. See job description for additional skill sets.
Req'd Education: Bachelor degree (or equivalent working experience) in Healthcare related field preferred. Advanced medical terminology, anatompy/physiology and coding courses in ICD9CM & CPT, knowledge of medical supplies & medical records.
Req'd Certification: Registered Health Information Technician, Registered Health Information Administrator or Certified Coding Specialist certification from AHIMA or Certified Procedural Coder eligible; to be acquired within one year from date of hire.