Quality Reviewer

Lexington Medical Center

1d

About The Position

The Quality Reviewer works closely with the Radiation Therapist, and carries out audits and reconciliation on accounts, charges, and chart documentation on all Radiation Oncology patients. This role ensures accounts are accurate and are prepared for final billing in a timely manner with Corporate Compliance. The Quality Reviewer ensures diagnostic codes are entered correctly in all systems of record; including ARIA and EPIC. The Quality Reviewer creates reports of department data for statistical trending and evaluation of services.

Requirements

• Minimum Education: High School Diploma or Equivalent
• Minimum Years of Experience: 3 years working in medical billing, coding, and/or insurance
• Substitutable Education & Experience: Associate Degree with 1 year relevant experience.
• Required Certifications/Licensure: N/A
• Required Training: Functional knowledge of computers and Microsoft products (Word, Excel, Outlook etc.). Procedural knowledge of medical terminology, ICD10, and CPT coding.

Responsibilities

• Audits charts initially, daily, and at completion of treatment for billing, charting, and documentation accuracy and thoroughness.
• Collaborates with Administrative Assistants and Professional Billers to ensure registration and authorization accuracy.
• Works in both ARIA and EPIC to add diagnosis codes for consult and follow up appointments.
• Informs supervisor and physicians when changes are needed based on CMS rules and insurance guidelines.
• Collaborates with clinical and technical staff for positive and negative trends.
• Works with Director to improve patient satisfaction and eliminate barriers to quality care.
• Collaborate with other hospital departments (Accounting, Coding, Insurance, Medical Records, Patient Financial Services) to create timely billing and eliminate payment denials.
• Collaborates with Director and other staff to maintain up-to-date hospital chargemaster, staying current with latest CPT rules and reimbursement issues.
• Tracks and trends monthly and yearly statistical data for Accounting, LMC Administration, and DHEC.
• Discharges all HRON (Radiation Oncology) accounts after completion and chart close out.
• Performs all other duties as assigned.

Benefits

• Day ONE medical, dental and life insurance benefits
• Health care and dependent care flexible spending accounts (FSAs)
• Employees are eligible for enrollment into the 403(b) match plan day one. LHI matches dollar for dollar up to 6%.
• Employer paid life insurance – equal to 1x salary
• Employee may elect supplemental life insurance with low cost premiums up to 3x salary
• Adoption assistance
• LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
• Tuition reimbursement
• Student loan forgiveness

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED