Genesis Health System Doc Reviewer, General Equip in Davenport, Iowa
Position Title: Doc Reviewer, General Equip
Purpose: Reviews and analyzes medical documentation for qualification of medical equipment. Is responsible for assuring correct documentation to meet insurance guidelines for HME equipment and supplies. Will assist with staff and referral education on guidelines and compliance issues.
Report To: Manager, GHME
Supervisory Responsibility: Direction: The job requires some accountability for scheduling, assigning or coordinating work. Employees check the quality of work and provide guidance, instruction, training and direction to others. Although the job does not require formal or official supervisory responsibility, the incumbent serves as group leader or acts in an informal "assistant supervisory" or "lead" role. In addition, the employee may be expected to provide information or suggestions on human resources matters.
Materials Responsibility: High: Work requires a high degree of responsibility for material resources. Examples of resources could include large operating or capital budgets for a large functional area, major plants, facilities or properties, or other equivalent material assets. The employee has a large amount of control over these resources. The cost of errors might result in significant financial loss and affect overall corporate results. The difficulty, variety and depth of problems associated with these material resources is moderately complex.
Key Relationship: Co-workers/Health System Employees, Outside Agencies/Other Health Care Providers, General Public/Visitors/Volunteers, Physicians/Medical Office Staff, Students/Interns/Residents/Outside Instructors, Patients, Families, and Significant Others, Third Party Payors/Insurance Companies, Auditors/Review Agencies
Education: 2 year college program or equivalent experience
Field Of Study:
Special Training: Extensive knowledge of HME medical necessity documentation requirements with a broad experience in the home medical equipment setting.
Training Preferred: Knowledge of ICD and HCPCS coding system; federal and commercial payment systems; experience with insurance and medical background.
Experience: More than 3 years experience required.
Interpersonal Skills: Interaction is with a wide variety of people inside or outside the organization. Communications are often extremely difficult or stressful in nature. Contact with others involves highly complex and sensitive topics. The job requires extremely well developed interpersonal skills for dealing with a range of complicated problem situations. The job requires the use of diverse communication techniques.
Working Conditions: There is exposure to some undesirable or unpleasant environmental characteristics. The physical environment is generally safe and there is minimal health risk. No safety equipment or unusual precautions are required. Exposure to these conditions would be limited to 70% or less of the work day.
Possible Exposure to Blood Borne Pathogens: Yes