Failed Claims Specialist

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Job Title:

Failed Claims Specialist

Department:

Health System Shared Services MIM CDI and Coding

SCOPE OF POSITION

By working under the supervision of the direct manager, The Charge Capture Specialist is responsible for optimal and quality charge entry related to all inpatient and outpatient separately billable services. Conduct thorough review of the medical record to ensure that the clinical documentation supports all billed charges. Take an active role in identifying the discrepancies in nursing documentation and report findings to nurse managers. Follow up on all incomplete & inaccurate charges and makes corrections promptly. Establish a strong working relationship with the nursing, revenue, and administrative staff. Maintain a working knowledge of CPT coding guidelines and government rules and regulations. Review daily reports generated to check prior day's charges for accuracy. Help in educating the clinical staff on what is considered a billable service based on governmental regulations and guidelines. Take a role in maintaining charge capture policies and procedures manual and in training new staff. Abide by OSUWMC and the James policies, procedures, and code of conduct. Perform other duties as directed and assigned.

POSITION SUMMARY

The Charge Capture Specialist is primarily responsible for charge capture for the various inpatient and outpatient departments affiliated with the James Cancer Center. This position contributes to the day to day operations of the nursing units and adheres to OSUMC and James policies and procedures, including the organization's compliance program. The Charge Capture Specialist utilizes Relationship-Based Care to guide professional practice and embraces the James's mission, values, and standards by providing positive customer relations and achieving goals consistent with Key Results Areas which includes endorsing the organization's compliance program, maintaining infection control standards and implementing patient safety protocols as necessary.

In keeping with the James Nursing mission, vision, and value statements, participation in volunteer activities for the community and professional organizations is highly encouraged and supported.

Minimum Requirements

Per Classified Civil Svc Specs or equivalent combination of education and experience. Minimum requirement is high school diploma or general education degree (GED). Bachelor's degree in healthcare or healthcare related field and equivalent experience is preferred. Workable knowledge in medical terminology is required. Strong computer skills in areas of data mining and data analysis are desired. Coding certification is desired.

Additional Information:

Location:

Ackerman Rd, 660 (0242)

Position Type:

Regular

Scheduled Hours:

40

Shift:First Shift

Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.

Thank you for your interest in positions at The Ohio State University and Wexner Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the Candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status. For answers to additional questions please review the frequently asked questions.

The university is an equal opportunity employer, including veterans and disability.

As required by Ohio Revised Code section 3345.0216, Ohio State will: educate students by means of free, open and rigorous intellectual inquiry to seek the truth; equip students with the opportunity to develop intellectual skills to reach their own, informed conclusions; not require, favor, disfavor or prohibit speech or lawful assembly; create a community dedicated to an ethic of civil and free inquiry, which respects the autonomy of each member, supports individual capacities for growth and tolerates differences in opinion; treat all faculty, staff and students as individuals, hold them to equal standards and provide equality of opportunity with regard to race, ethnicity, religion, sex, sexual orientation, gender identity or gender expression.

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