The EMR Rep is responsible for maintaining and processing all patient medical records. The ideal candidate is a great multitasker that can handle multiple administrative duties at once. Candidate will prepare reports daily that will consist of assembling, analyzing, releasing, processing, collecting, and reconciling information in a manner consistent with medical and regulatory requirements. Must have excellent verbal and writing skills.

Job Duties:                

• Create and maintain medical records for each client
• File and retain records in accordance with appropriate regulations
• Contact clients when needed and answer questions when appropriate
• Mentor other employees about electronic medical records
• Assess current procedures and provide more efficient alternatives when necessary
• Analyze medical records for completeness and gather additional information when needed
• Work independently and communicate clearly with patients, their families, and staff members

Requirements:

• High School Diploma, GED, or equivalent required
• Associate’s degree preferred
• Minimum 1 year work experience required
• Previous employment in an office setting
• Basic knowledge of computers and Microsoft Office
• Knowledge of medical terminology preferred

The cardiovascular technologist conducts invasive and non-invasive examinations of the cardiovascular and pulmonary systems to assists with the diagnosis and treatment of patients with heart, lung, or blood vessel illnesses. They also assist with maintaining the equipment used to ensure ongoing accurate test results. Candidate must be detailed oriented in creating and retaining patient records for efficient treatment.

Job Duties:

• Verify and record patient medical history and other necessary clinical data
• Answer any patient questions about the procedure pre and post examination
• Use proper judgement when performing services and only perform the necessary
• Perform diagnostic examinations of patient’s cardiovascular or pulmonary systems
• Record data relating to the patients anatomy, pathology, and psychology for physicians to assess
• Conduct non-invasive procedures like echocardiograms, or vascular ultrasounds
• Conduct invasive procedures like cardiac catheterization, or cardiac electrophysiology
• Adhere to applicable legal regulations while ensuring a safe and secure work environment
• Constant self-education of industry news and procedures via professional organizations, networking, and other educational opportunities.
• Ability to work in a team environment to ensure the best treatment for the patients

Requirements:

• Associates Degree in Cardiovascular Technology
• Certification in an area of cardiovascular technology required
• Certified from an accredited Cardiovascular Technologist School required
• One or more years of experience in a catheterization lab preferred
• Basic computer knowledge required

The Credentialing Specialist keeps abreast of government and accrediting agency standards for persons employed in health care facilities. This candidate will ensure that staff members and facility credentials meet the appropriate requirements to operate and perform their job.

Job Duties:

• Prepare reports with accurate data for all health care providers
• Verification of practitioner legitimacy via licensing agencies, universities, certification bodies, etc
• Maintain an active database of training, licenses and other credentials for practitioners
• Ensure staff members adhere to staff and department regulations and laws
• Audit health plan directories for current and accurate provider information
• Track certification expiration for all staff members and ensure timely renewals
• Ensure company is operating in accordance with health plans and government regulations
• Performs other duties as needed

Required Qualifications:

• Associate’s degree in healthcare or business administration
• 1 year experience in a medical office
• Professional certification preferred
• Relevant credentialing preferred
• Proficient in using a computer and Microsoft Office

The purpose of the prior authorization nurse is to provide timely review of authorization requests and ensure the requests meet national standards and contractual requirements. The prior authorization nurses will also promote the quality and cost effectiveness of patient care using clinical acumen. Additionally, the nurses will prepare documentation, perform audits of patient records, and assist management as needed.

Daily Responsibilities:

• Perform clinical reviews of authorization requests using appropriate criteria
• Provide accurate and complete documentation with rationale used to approve request
• Collaborate with various staff within provider networks and case management team coordinate patient care
• Equip and train prior authorization tech with needed resources
• Ability to multitask between computer and multi-line phone requests
• Participate in interdepartmental projects when needed
• Enter and maintain clinical information in multiple health management systems

Skills and Qualifications:

• Bachelor’s or Associate Degree in Nursing (Bachelor’s preferred)
• State licensure as a Registered Nurse (RN)
• Minimum of two (2) years of experience in acute clinical nursing setting
• Knowledge of utilization management and case management principles preferred
• Prior authorization experience preferred
• Advanced verbal, written communication, and organization skills
• Knowledge of Microsoft word
• Drive to work well with a team
• Strong service orientation and professionalism

A Claims Analyst in the Healthcare field processes medical claims by verifying and updating information about submitted claims and reviewing the work processes required to determine reimbursement. They would be responsible for providing billing analyses of claims and applying standards of federal regulations to ensure correct billing practices.

Job Duties

• Application of policy and provider contract provisions to determine if a claim is payable. If additional information is needed, or if a claim should be denied.
• Determine the status of medical claims through research
• Reviewing charges, and use of payment or denial codes within established guidelines and standards
• Maintenance of records, files, and documentation
• Meet the standards of department production and quality standards

Qualifications

• In some cases, a High School diploma may be adequate when accompanied with the appropriate amount of related experience
• Generally though, a Bachelor’s degree in a related field is preferred
• In some cases, a current nursing certification is required
• Strong knowledge of related skills is strongly preferred. Experiences such as inpatient/outpatient hospital billing, revenue codes, and itemization of charges
• Auditing and health information management experience in a healthcare setting is preferred
• Strong proficiency in Microsoft Office, and general computer skills

HEDIS, the Healthcare Effectiveness Data and Information Set is a set of guidelines used by over 90 percent of healthcare plans in the U.S. to measure clinical care performance and service. HEDIS was developed by the National Committee for Quality Assurance (NCQA) to establish standard performance measures.

A HEDIS Nurse is trained in the 81 measures of performance for patient care that span 5 domains of care. HEDIS Nurses use this knowledge to help educate others on the approved processes and procedures including accepted medical record keeping and coding procedures. They are especially important in improving the quality of care given in a healthcare facility and in documenting progress and reporting to healthcare plan providers. To do this, the HEDIS Nurse works with physicians, other clinicians as well as facility management to assess the situation and report on progress toward the goal of meeting HEDIS guidelines and improving overall patient care.

Revenue Cycle Management is responsible for a medical facility’s Collections Services and Patient Billing departments. The major function is to develop and manage billing, collections and reimbursement.

Revenue Cycle Managers are tasked with increasing positive cash flow for the facility by implementing successful procedures of billing and collections so that patient accounts are paid in a timely manner. Revenue Cycle Management must understand Federal and State Laws regarding medical billing and collections and must make sure the department follows these procedures in the collection of patient debts.

The Manager of Quality Improvement is responsible for overseeing the processes and improves the activities of a medical facility to help make the facility’s processes more efficient and effective. This position will compile information about clinical processes and provide reporting on the status and improvements to the healthcare facility’s senior management. The Manager of Quality Improvement develops a strategic plan for improvements, working with both the facility’s administrative staff and the clinical staff to implement the plan and track progress.

Medical Billers/Medical Coders are employed by healthcare facilities to review a patient’s medical records and assign billing codes to procedures a patient receives during treatment. These codes are used by insurance companies or other third-party payers to determine the patient’s benefits under their plan.

Medical Billing/Medical Coding professionals may work remotely in their home or in an office of a medical facility including hospitals, physicians’ offices or clinics. In addition to basic office skills like filing, typing and managing paperwork, this position requires considerable knowledge about medical terminology and medical coding along with strong communication skills.

Based on established medical review standards a Concurrent Review Nurse reviews a patient’s medical records and helps make a decision on whether a patient will continue to remain at a healthcare facility or be discharged.

Concurrent Review Nurses work with the patient’s treatment team to determine the overall health of the patient and determine if they are receiving treatment that is consistent with their diagnosis and symptoms. They may also speak with the patient and family members to get an overall picture of the patient’s current medical state and their wishes regarding further treatment.

Concurrent Review Nurses create a report detailing the current patient status and to make sure the care they receive meets the standards of the healthcare facility. With this information in hand, they will create a plan for further treatment and eventual discharge from the facility.