Renal Dialysis Financial Specialist - Hemodialysis - FT - Day

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization.  As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

The listed minimum pay reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).

Minimum Pay:

Position Overview

SUMMARY (Basic Purpose of the Job)

MINIMUM REQUIREMENTS

Education: High School diploma or equivalent.

Experience: Three years related experience in medical office or hospital setting. Experience with electronic health record preferred.

Other Credentials:

Knowledge and Skills: Intermediate knowledge of medical terminology, ICD-10 and CPT codes. Excellent verbal and written communication skills. Strong interpersonal and organizational skills.

Special Training: Proficient with Microsoft office applications.

Mental, Behavioral and Emotional Abilities: Ability to quickly change priorities when necessary to meet deadlines. Demonstrates good judgment as well as attention to detail. Ability to function as a team member and appropriately seek supervision as needed. Ability to work independently and be self motivated. Ability to maintain confidentiality of patient information. Ability to interact with all levels of staff in a courteous and professional manner.

Usual Work Day:8 Hours  

Reporting Relationships

Does this position formally supervise employees? No

If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.

ESSENTIAL FUNCTIONS

• Interviews patients/family to acquire registration, financial and insurance information. Provides individualized assistance to patients, families and caregivers to help overcome potential barriers such as lack of insurance, financial issues, managing health care expenses and any other financial related problems that may arise during treatment.
• Validates insurance coverage, determines priority of payer and acquires identification, signatures, pre-certifications and/or authorizations for services that will facilitate processing claims by payer and facilitates maximum utilization, efficiency, and minimal procedure-related problems.
• Discusses, instructs and explains to patient procedures and guidelines for coordination of benefits, optimizing insurance coverage and/or payment of dialysis-related bills. Advises patients of and obtains all necessary pre-certification and referrals needed for financial reimbursement. Assists patient, family and caregiver with understanding of their insurance coverage specific to their treatment and related services.
• Acts as a financial liaison between patient, insurance companies, physician offices and Business Office to discuss issues, resolve coverage and/or payment problems. Troubleshoots any issues related to financial integrity and accuracy of documentation and/or insurance requirements of account. Resolves these issues with internal departments and external offices.
• Provides necessary information and support to Business Office and/or Medical Records with acquisition of pertinent patient information required for payment of services. Works in conjunction with all members of patient's medical care team. Works closely with other medical team members to be a resource for team member and patient.
• Collaborates with Quality Insights Renal Network 3 in reference to submission of Federal/State required patient information relative to enrollment into ESRD program and changes in patient status.
• Works with Director of Renal Dialysis Services/Nurse Manager on patient acceptance into or transfers out of program. Assesses financial needs of new and established patients to identify those who may have financial challenges related to their care. Meets with all newly diagnosed patients as a member of their treatment team.
• Conducts reviews for Medicare, Medicaid beneficiaries, as well as private insurers and self pay patients, based on appropriate guidelines. Performs concurrent and retrospective reviews with various payers, utilizing appropriate guidelines as demonstrated by compliance with all applicable regulations, policies and timelines. Adheres to CMS guidelines for utilization reviews evidenced by utilization of relevant guidelines and appropriate referrals.
• Obtains information and signatures to complete ESRD Medicate entitlement form and application for health insurance benefits and death notification.
• Ensures logs and records are maintained as directed. Performs environmental monitoring and reports significant findings to management for follow-up.
• Oversees day-to-day operations of inpatient and outpatient medical record assembly, analysis, and scanning functions. Ensures staff prioritizes daily workflow and maintains order to department's medical record room. Assures timely collection, packing, scanning, and completeness of discharged medical records.
• Provides critical information to incoming Unit Secretaries to assure compliance with department policies regarding chart order and thinning process.
• Maintains accuracy of offsite storage logs to facilitate requesting medical records for patient care and legal requests.
• Participates in Joint Commission and other regulatory readiness and preparation activity, as directed.
• Performs other duties as assigned; willingness to adapt to changing department demands.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

Frequent physical demands include:

Occasional physical demands include: Standing , Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Taste or Smell

Continuous physical demands include: Sitting , Pinching/fine motor activities , Keyboard use/repetitive motion , Talk or Hear

Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.

Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Accurate Color Discrimination, Accurate Depth Perception, Accurate Hearing

Anticipated Occupational Exposure Risks Include the following: Bloodborne Pathogens , Chemical , Airborne Communicable Disease , Uneven Surfaces or Elevations , Dust/Particulate Matter

Offers are contingent upon successful completion of our onboarding process and pre-employment physical.  Capital Health will require all applicants to have an annual flu vaccine prior to start date, with the exception of individuals with medical and religious exemptions.

For benefit eligible roles, in addition to cash compensation, we provide a comprehensive and highly competitive benefits package, with a variety of physical health, retirement and savings, caregiving, emotional wellbeing, transportation, robust PTO plan, overtime to eligible roles, and other benefits, including "elective" benefits employees may select to best fit the needs and personal situations of our diverse workforce.

The pay rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity.  Bonus and/or incentive eligibility are determined by role and level.

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare.  Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.