Ensures that patient care services are delivered in a manner that balances quality of care with efficiency, cost-containment and compliance with regulatory requirements.
• Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria.
• Assesses and coordinates patient's discharge planning needs with members of the healthcare team.
• Develops, implements and facilitates quality evaluation and improvement initiatives.
Competencies and skills:
• STANDARDS OF BEHAVIOR: Acts in a manner that supports the standards of communication, respect, privacy, and teamwork by demonstrating a commitment to professional and ethical conduct.
• CUSTOMER SERVICE: Demonstrates commitment to service excellence by promptly addressing internal/external customer issues/requests, resolving concerns while maintaining a professional image and behavior to build and enhance the patient/family/customer experience.
• ACCOUNTABILITY: Accepts ownership of job roles and specific assignments/goals; works independently, takes responsibility for own actions; admits mistakes and judgment errors; and accepts constructive feedback. Connects personal work results to the accomplishment of team and organizational goals.
• RESPONDING TO CHANGE: Accepts change and adapts in a positive and productive manner; handles unexpected situations and changes in direction calmly and with confidence. Views new assignments and job responsibilities as an opportunity for growth.
• CLINICAL DOCUMENTATION REVIEW: Conducts clinical documentation reviews to ensure that appropriate reimbursement is received for services rendered.
• BILLING: Processes accurate payor claims to ensure timely reimbursement.
• ORGANIZATION SKILLS: Organizes work to achieve maximum efficiency.
• MANAGING INFORMATION: Utilizes effective methods to receive, process, apply, verify and/or store information.
• PATIENT AND FAMILY CENTERED CARE: "Provides Patient and Family Centered Care to patients, families, visitors and internal customers"
• MEDICAL CODING: Transforms verbal descriptions of diseases and procedures into numeric designations.
• Accredited Program
• Registered Nurse License
Education equivalent experience:
• Graduate from an accredited nursing program
Complexity of Work: Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.ed.
Required Work Experience: 1 year
• Keyboard Entry 80.00%
• Repetitive Movement Hand/Arm 80.00%
• Sitting 80.00%
• Standing 80.00%
• Walking 80.00%
• Audible Speech 80.00%
• Hearing Acuity 80.00%
• Depth Perception 80.00%
• Distinguish Color 80.00%
• Seeing - Far 80.00%
• Seeing - Near 80.00%
• Computer Monitor 80.00%
Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.