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Job Description

Radiology Reimbursement Analyst

SUMMARY Works as a team member to accomplish goals of the Munson Healthcare Radiology Department, as well as organizational goals. Responsibilities include accurate charge capture practices, compliance to the guidelines published by the Centers for Medicare and Medicaid Services (CMS), investigation and resolution of account discrepancies, updating Radiology staff regarding billing and coding changes, analysis of the impact to the department, and submission of data to regulatory agencies. Works directly with the Radiology Information Systems Analyst and has a strong working relationship with multi-disciplinary teams to ensure effective implementation, maintenance, and compliance of the Radiology charging process in a way that promotes and supports MHC's True North goals.

ENTRY REQUIREMENTS

Bachelor's degree in Business Administration or Health Care field. In lieu of Bachelor's degree, a minimum of two years of experience of analytical and financial healthcare experience is required.

Accreditation by AHIMA: CCS, RHIT OR RHIA or enrolled in an AHIMA program to qualify for accreditation. Accreditation must be obtained with two years of hire.

Knowledge of CPT, ICD-10-CM, ICD-10-PCS, is required.

Experience in Radiology preferred.

ORGANIZATION

Works under the general supervision of the Manager and Director of Radiology.

Must maintain a professional working relationship with staff from Radiology, Patient Access Services, HIS, PAS / Business office, Information Systems and physician office staff.

Must maintain a professional working relationship with Munson affiliates.

SPECIFIC DUTIES

  1. Supports the mission statement of Munson Medical Center (MMC): Munson Medical Center is the core of a regional health system. In partnership with physicians, we provide quality, compassionate, comprehensive and cost-effective services for improvement of the health of our patients and the communities we serve. 2. Embraces and supports the Continuous Quality Improvement (CQI) philosophy of Munson Medical Center: We are committed to the name "Munson" meaning excellence. We will provide services that meet our customers' requirements every time. 3. Supports Munson Healthcare True North framework where patients are at the center of all we do.

  2. Acknowledges that safety is a self-responsibility. Knows the physical requirements of the job and work within those guidelines. Performs job duties safely at all times, utilizing learned body mechanics and transferring/lifting techniques. Plans actions to promote safety. Reports any unsafe situation/equipment according to Hospital procedure.

  3. Performs other duties and responsibilities as assigned.

    SPECIFIC DUTIES - REIMBURSEMENT ANALYST

    • Responsible for Radiology charging practices for Munson Health Care. • Maintains Radiology Charge Masters for Munson Health Care. • Reviews and resolve discrepancies on Daily Billing Report, investigates, communicates and educates. • Oversees, reviews, trouble shoots MR coding or Radiology procedures. • Point Person for audits of Radiology charges and documentation. • Implements proper charging for new Radiology procedures including education, documentation and follow-up. • Monitors publications regarding Radiology reimbursement. Analyzes impact on the departments, implements changes as needed. • Develop and implement processes for compliance to charging guidelines. Monitors, resolves, communicates and educates. • Monitors monthly rejection reports, investigates, resolves, communicates and educates. • Runs edit reports. • Review and resolve Console Errors logs. • Answers billing questions from Patient Accounts. • Assists patients with obtaining prior authorization for Radiology procedures by furnishing billing codes and other information. • Communicates with GT Radiologist PC regarding documentation and charging issues. • Enters late charges and credits as needed. • Works with PAS to resolve patient registration problems. • Works with ad hoc committees that involve Radiology policies.

    SPECIFIC DUTIES - INFORMATON SYSTEM SPECIALIST

    • Responsible for the Radiology Information systems for Munson Health Care. These systems include STAR Radiology (HBOC), MRS, Cerner/PowerChart and PACS. Monitors, resolves issues, communicates and educates as needed. • Point Person for IS Help desk and Radiology-Powerchart issues. • Problem solves issues regarding the RIS. Investigates, resolves, communicates and educates. • Runs ad hoc reports via Access, Excel and Star reports as needed. • Coordinates implements RIS when necessary; analysis, process re-design and development. Provides staff education. • Serves as department liaison to the Powerchart Group. Works with IS to resolve related issues. Serves on various IS committees. • Serves as the Radiology STAR Coordinator. Works with other hospital STAR Coordinators and their products. • Works with RIS's vendors. • Assists and participates in RIS evaluation, decisions and implementation. • Handles system up-grades. Performs testing, communicate and educates staff. Assists during downtime. • Staff training. • Works with PAS by training and monitoring staff issues. • Maintains the MRS program. Performs data maintenance problem solving and employee training.

    REGULATORY AGENCIES CONTACTS

    • Responsible for MMC MRI data submission to MDPH as required. Runs audit, investigates, resolves, communicates and educates as needed. • Responsible for Munson Healthcare Radiology CT CON submission data. • Point Person for charging and documentation audits by outside agencies such as Blue Cross and Medicare.

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