ESRD Specialist

Title:  ESRD SpecialistFLSA Status: Non-exemptShift: Monday-Friday, typically 8am-5pmReports to:  Revenue Cycle ManagerDepartment:  Revenue CycleEmployment Status: Full-timeSupervisory Responsibilities:  NoLocation: Greenville EastDate Created/Last Evaluated: 09/13/2023 | 04/09/2024Summary
Responsible for handling all issues relating to End Stage Renal Disease (ESRD) patients.  This includes but is not limited to all ESRD patients seen at any of the dialysis units and hospitals as well as any transient ESRD patients.Qualification Requirements
Must be proficient in processing medical insurance claims. Knowledge of medical billing/collection practices and above average understanding of debits and credits are required. Basic medical coding and third-party operating procedures and practices is required.Minimum Qualifications

• High School Diploma or equivalent
• 2 years of medical insurance claims experience
• Ability to read and interpret the most current CPT and ICD coding is preferred.
• Proficiency in Microsoft Office (Word, Outlook, Excel).  Above average understanding and proficiency using word processing and spreadsheets.
• Computer skills also include knowledge of applicable EHR, Practice Management, Allscripts PM, Clinical Module Medical Records and Document Manager systems.
• Familiarity with CMS 1500 claim form completion.
• Passage of a criminal background check, OIG exclusion, and drug screenings.
• Valid driver’s license and reliable transportation.

Knowledge, Skills and Abilities

• Detail oriented and excellent records maintenance skills.
• Ability to communicate effectively both orally and written.
• Proactive individual with the ability to be a self-starter with strong independent decision-making skills and attention to detail.
• Ability to foster a cooperative work environment.  Possess willingness to accept direction and guidance and to perform repetitive tasks.
• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
• Knowledge of healthcare billing procedures, documentation, and standards.
• Knowledge of appropriate billing and payment cycles for third party payor accounts.
• Ability to make evaluative judgments.
• Skill in the use of personal computers and related software applications to include word processing, outlook, and excel.
• Ability to function well while involved in multiple task assignments.  Ability to concentrate on details and deal with constant interruption.  Skill in organizing resources and establishing priorities.
• Knowledge of operational characteristics and procedural requirements of third-party payors.
• Knowledge of procedural requirements and ethical standards for follow-up of overdue accounts.
• Ability to analyze medical records and identify billable services.
• Knowledge of credit and collection principles, process regulations, and standards.
• Attends and completes in-service training as required.
• Knowledge of HIPPA and other compliance requirements

Supervisory Responsibilities
NoneEssential Functions

• Ensures ESRD patient account information is accurate and up to date. This includes patient demographic and insurance information.  Including authorizations from insurance carriers.
• Responsible for maintaining ESRD patient rosters in Rounder (formerly Acumen 1.0).
• Maintaining a good work relationship with each dialysis unit
• Processing and posting of monthly capitation charges for all ESRD patients in a timely and accurate manner.
• Ensuring transients’ information is received and processed in a timely manner.
• Responsible for preparation of new dialysis patients and Home Therapy training packets.
• Ensure charges for self-care training patients are processed in a timely and accurate manner.
• Keeping Revenue Cycle Manager up to date on any changes affecting ESRD billing and reimbursement.
• Adhere to all billing requirements of third-party payors.
• Maintain confidentiality and adhere to all HIPAA guidelines and regulations.
• Follow all safety policies and procedures. Recommend changes or updates as needed to safety policies and procedures.
• Participates in required safety training and drills.
• Attends department and organizational staff meetings as required.
• Keep all reference material, monthly bulletins, manuals, and forms organized.
• Perform related work as required to accomplish the mission of the organization.

 Essential Task (This should have no more than 8 essential tasks, realistic is 5% of Time Process monthly dialysis charges for all ESRD/Transient/Home Therapy patients35%Process new patient start packets when needed for new dialysis starts5%Maintain patient rosters in Acumen 1.025%Maintain assigned WQ for ESRD patient in Acumen 2.015%Work the Self Pay A/R for all ESRD patients15%Other duties as assigned5%Physical Demands

• The employee must frequently lift and/or move up to 10 pounds. The employee is expected to use the appropriate tools provided such as hand carts to carry heavier loads.
• This position requires eyesight (corrected or uncorrected) that allows the employee to accurately read job related materials, accurately read and record patient related information, and any other functions that require the employee to accurately see data.
• Keying of data requires repetitive motion.
• While performing the duties of this job, the employee is regularly required to stand and talk or hear.
• The employee is occasionally required to sit and stoop, kneel, or crouch and requires full range of body motion, manual and dexterity and eye-hand coordination.
• The employee is required to spend a significant amount of time on the phone and therefore is expected to use the hands-free headsets provided to help avoid injuries.

Work Environment
Work Schedule is Monday- Friday, 8 am to 5 pm. Slight modifications may be made to this schedule with approval from the manager. Work is normally performed in a typical interior/office work environment.  The noise level is usually moderate. Low risk of exposure to blood borne pathogens and OPIM. Must be able to work overtime hours as needed to accomplish the mission of the organization.













 

Benefits: 401(k) includes Safe Harbor and Profit Sharing / Choice of Medical Insurance Plans / Dental / Paid Disability and Life Insurance / Optional Life, Accident and Critical Insurance / Generous Paid-Time-Off

Eastern Nephrology is the region’s largest, private medical practice specializing in diseases and disorders of the kidney. Our continued growth is a direct result of providing excellent service and care to our patients. ENA is always seeking talented and compassionate clinical and administrative people to join our practice family.

Eastern Nephrology is an equal opportunity employer. Applicants will not be discriminated against because of race, color, creed, sex, sexual orientation, gender identity or expression, age, religion, national origin, citizenship status, disability, ancestry, marital status, veteran status, medical condition, or any protected category prohibited by local, state or federal laws. We are an E-Verify Employer. Pre-employment background checks are required for all employment positions. If you are a qualified individual with a disability and are unable or limited in your ability to use or access the online application system process due to your disability, please contact the Human Resources Department at 252-864-2049 to request assistance. The company provides reasonable accommodations to qualified individuals with a disability to enable them to effectively participate in the application process, as required by law.

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