Health Information Management Denial Prevention Analyst

Pagosa Springs Medical Center

Introduction:

Pagosa Springs Medical Center has an opening for a Health Information Management Denial Prevention Analyst. This position is responsible for conducting analytics as it relates to medical necessity of patient claims. Analysis will include review of the Local and National Coverage Determination as defined by Medicare (CMS) and/or Novitas to maximize revenue realization. These efforts will result in increased net revenues by reducing claim denials from potential write-offs due to lack of appropriate diagnosis coding to meet medical necessity. Interactions will primarily be conducted with health care providers and PSMC business office personnel. Resumes and applications must be submitted to mitzi.bowman@psmedicalcenter.org or faxed to (970) 731-0907. Pagosa Springs Medical Center is an EEO employer.

Job Description:

Essential Duties, Functions and Responsibilities:

At all times, employee shall be able to perform the following essential functions of the job, with or without an accommodation, as set forth below.

  • Analyzes patient chart for appropriate coding as defined in the LCD/NCD policies published by CMS and/or Novitas.
  • Analyzes patient chart for completeness as well as for deficiencies of the physician of record
  • Answers the telephone and greets customers to the department.
  • Faxes and mails provider queries to physician offices, medical facilities, etc.
  • Assists with routing deficient records to correct physician for completion
  • Maintains patient confidentiality at all times, with patients, physicians, visitors and co-workers.
  • Continually strives to establish and maintain a good rapport and working relationships to foster positive intra and interdepartmental communications.
  • Maintains patient confidentiality at all times, discussing patient or hospital business only with immediate supervisor as needed.
  • Employs tact and courtesy at all times with patients, physicians, visitors and co-workers. Continually strives to establish and maintain good rapport and communications
  • Knows and practices the prescribed vision, mission, core values and standards of Pagosa Springs Medical Center.
  • Adheres to the hospital dress code.
  • Reports to work when scheduled, not absent without prior notification.
  • Completes assigned work, does not leave unfinished tasks for others to complete.
  • Prioritizes tasks so that the most important tasks are completed first.
  • Interacts with other department and staff members in a manner which promotes optimum service to the patients and/or the public.
  • Fosters good will among the staff members and community.
  • Demonstrates willingness to perform tasks of a reasonable nature as directed by the supervisor.
  • Upholds Pagosa Springs Medical Center confidentiality policy, and upholds HIPPA Privacy Law.
  • Supports supervision and adheres to hospital policies in a positive and constructive manner.
  • Treats employee wages and salaries confidentially.
  • Initiates action to prevent the occurrence of any potential problems or nonconformities relating to patient care or supporting activities.
  • Initiates, recommends, or provides solutions through designated channels.
  • Discontinues treatment of the use of defective supplies or equipment until the condition has been rectified.
  • Maintains competency through education, training, and in-service activities
  • Can perform all the standard job requirements.
  • Meets the qualifications as set forth herein.

Required Qualifications:

  • Must have experience in an office setting
  • Must have knowledge of basic computer applications
  • Prefer experience in a health care setting
  • Prefer knowledge of health insurance and reimbursement/billing
  • Prefer ability to comprehend payor responses
  • Prefer knowledge of Medical Terminology

Education Qualifications:

High school diploma and basic knowledge of claims processing, finance, health care operations or collections

Compensation/Benefits:

Full benefits including:

  • Retirement
  • Health
  • Vision
  • Dental
  • Prescription
  • Life Insurance
  • Paid Time Off

Instructions for Resume Submission:

Resumes and applications must be submitted to mitzi.bowman@psmedicalcenter.org or faxed to (970) 731-0907.