Surgical Review Specialist, Full-time(Remote)
Job details
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Surgical Review Specialist prospectively reviews, validates, and audits procedure code assignment in accordance with AHA ICD-10-CM and AMA CPT-4 coding conventions, UHDDS guidelines and CMS directives. Researchs failed claims, identifies discrepancies and communicates resolution to appropriate departments. JOB DUTIES AND RESPONSIBILITIES:
- Prospectively reviews, validates, and audits OR procedure code assignment for HIM, OR and/or general surgery cases according to AMA CPT-4 coding conventions utilizing EPIC and/or other OR applications as appropriate
- Identifies potential patient class mismatches based on planned OR Surgical CPT-4 assignment for all scheduled OR cases
- Ensures that appropriate IP patient class is obtained for IP only Medicare cases prior to date of service
- Ensure all IP only procedures for Medicare cases have an Inpatient order prior to discharge as well as communicate all IP only procedures for commercial insurance
- Conducts reviews of cases lost with feedback to respective departments
- Conduct concurrent review with utilization review department for post op surgical cases with potential status issues, procedure changes or entry of incorrect patient class orders to ensure accurate patient status prior to discharge
- Audit CPT -4 codes provided by coders to ensure accuracy and correct patient class obtained prior to discharge, communicate back to PEC for re-authorization, as needed
- Is a resource to the Coding department, SLPG practices, providers, Pre-Encounter Center, Utilization Review Department and Billing department
- Assists with outstanding HIM Waiting for Information queues researching outstanding inpatient and/or outpatient accounts for resolution. Research may include, but is not limited to, missing documentation, outstanding OR dictations, incorrect and/or missing charges, incorrect CPT code assignment, incorrect registrations and/or physician queries
- Serves as liaison between Physician Advisor/Medical Director, Finance, Utilization Review Department and CDCI.
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