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Data Quality Specialist

Company: Aspen Valley Hospital
Location: Snowmass
Posted on: October 14, 2019

Job Description:

Job Summary: Responsible for the accuracy of medical record documentation, including but not limited to:# billing review to assess appropriate capturing of charges based on medical record documentation, review of dictated and hand-written entries in medical record to assess for compliance with regulatory and accrediting agencies, coordinating the CHA patient population discharge data program, coordinating payer audits, and assisting with medical record functions as necessary. ESSENTIAL JOB DUTIES# Reviews billing records in comparison with medical record documentation Trends and reports results of charge capture reviews for department/administration action Reviews medical record documentation for compliance with regulatory and accreditation requirements Trends and reports results of medical record reviews for medical staff action Prepares monthly discharge data for reporting to CHA SERVICE EXCELLENCE/CUSTOMER SERVICE Demonstrates purposeful service excellence through exceeding patient and coworker expectations. Represents the department/hospital as a dedicated, courteous, and responsive employee COMPLIANCE WITH RULES, REGULATIONS AND POLICIES Records pertinent documentation in accordance with regulatory requirements, professional standards and hospital policy. Adheres to federal, state and hospital rules and regulations concerning HIPAA privacy and security. Follows Hospital compliance plan and policies, including the Code of Conduct. Participates in required training for compliance related activities (HIPAA, Compliance, Patient Safety, TJC, etc.) UNIT SPECIFIC DUTIES # RESPONSIBILITIES / DAY TO DAY OPERATIONS Reviews patient account charges in comparison with medical record documentation to determine if charges are substantiated, within bill drop/hold time requirements. Trends and prepares monthly reports of review results, distributes to department directors and Compliance Committee members, and assists department directors in understanding those trends. Receives and responds to payor requested audits; prepares discrepancy or agreement paperwork based on results of said audits for payor and CFO. Prepares and submits monthly discharge data for reporting to CHA; edits incorrect or missing information as needed Reviews medical record documentation for compliance with regulatory and accrediting agency requirements, including but not limited to: -######### timeliness of documents (History and Physical, Discharge Summary, Consults) -######### completeness of documents (all elements required are met) -######### legibility of documentation Prepares monthly reports of said reviews for medical staff action PROFESSIONALISM Demonstrates responsibility and accountability for own professional decision making and professional growth. Participates and contributes to departmental meetings and activities. POPULATION SPECIFIC CRITERIA Demonstrates the ability to assess and interact with customers of all ages, recognizing language and learning barriers, and technology challenges. Able to state his/her duties during a code pink drill. CORE VALUES Patient Centered:is passionate about patient care, creating positive impressions on a consistent basis and exceeding our patients# expectations. Exhibits courtesy and sensitivity to the needs of patients and their families, responds with a sense of urgency to patient problems, anticipates patient requirements, responds proactively and places the patient#s safety above all else. Teamwork:works collaboratively with physicians and other staff and assists whenever possible. He/she openly shares information, provides feedback and participates in appropriate decision making as part of a team of healthcare professionals. Hospital and departmental objectives are placed ahead of individual agendas Respect for Others:actively listens to others, takes other opinions into account, and communicates openly and honestly.# He/she demonstrates respect for others by being timely with communications, completion of tasks, and meeting attendance.# The employee is respectful of all physicians, colleagues, patients, visitors, and other stakeholders Accountability:takes responsibility for his/her actions, abides by the hospital#s guiding philosophies and policies, and follows through on commitments and physician orders.# He/she provides complete and accurate information to the Physician and/or other members of the work team. takes personal pride and ownership in the quality of care and services provided to all internal and external customers Integrity:is truthful, trustworthy, and principled.#He/she#demonstrates character, conviction, and honest and ethical behavior in all interactions with others.##The employee#s word can be trusted.##Behavior is#consistent with these AVH Core Values KNOWLEDGE, SKILLS # ABILITIES # # EDUCATION/EXPERIENCE REQUIREMENTS # ######### High School Grade or GED equivalent ######### 2 years experience in data quality position in acute care hospital ######### 2 years experience in billing, claims, payor relations for hospitals # # LICENSE/REGISTRATION/CERTIFICATIONS # ######### RHIT/RHIA certification, preferred ######### CMAS certification, preferred # # KNOWLEDGE AND SKILL REQUIREMENTS # ######### Ability to concentrate and show attention to detail ######### Relatively high degree of analytical abilities ######### Strong interpersonal skills required ######### Ability to work independently ######### Medical Terminology ######### Anatomy and Physiology ######### Pathology and Disease Process ######### Knowledge of chargemaster, billing processes, payor relations, standards of documentation, and coding assignment. LANGUAGE SKILLS # ######### Ability to read and communicate effectively in English ######### Spanish preferred # WORKING CONDITIONS # ######### Normal patient care environment with little exposure to excessive noise, dust and temperature ######### May be exposed to communicable diseases through normal or careless performance of responsibilities ######### May be exposed to mechanical dangers associated with mechanical devices ######### May be exposed to stressful situations # # # DESCRIPTION OF PHYSICAL DEMANDS # PHYSICAL DEMANDS # On-the-job time is spent in the following physical activities.# ########################################################################## - Percent of Time- Stand:####################################################################### 10% Walk:######################################################################## 10% Sit:############################################################################ 80% Talk or hear:############################################################# 99% Use hands to finger, handle or feel:######################## 100% Push or pull:############################################################# 10% Stoop, kneel, crouch or crawl:################################## 10% Reach with hands and arms:##################################### 10% Taste or smell:########################################################## 00% # This job requires that weight be lifted or force be exerted. ####################################################################################### - Yes/ No - Up to 10 pounds:######################################################## yes## Up to 25 pounds:######################################################## yes## Up to 50 pounds:######################################################### no## Up to 100 pounds:####################################################### no### More than 100 pounds:################################################ no### # This job has vision requirements as follows:############# - Yes/No - Clear close vision:###################################################### yes# Clear distance vision:################################################## yes# Depth perception:####################################################### yes# Three-dimensional vision; ability to judge ## distances and spatial relationships:########################## yes# Ability to adjust eye to bring an object into ## sharp focus:############################################################# yes# WORK ENVIRONMENT # Job may have exposure to the following environmental conditions: ######################################################################################### -Yes/No - Wet, humid conditions (non-weather):######################### no### Work near moving mechanical parts:########################### no## Fumes or airborne particles:######################################### no### Toxic or caustic chemicals:########################################## no### Outdoor weather conditions:######################################## no### Extreme cold (non-weather):######################################## no### Extreme heat (non-weather):######################################## no### Risk of electrical shock:############################################### no### Work with explosives:################################################# no### Risk of radiation:######################################################### no### Vibration:##################################################################### no### # Hearing ability required for work environment is:### - Yes/No - Ability to hear alarms on equipment:########################## yes## Ability to hear patient call:########################################### no## Ability to hear instructions clearly:############################# yes## # ################################################################################## - Hi/Med/Lo - The typical noise level for the work environment is:############ low## # Repetitive Motion Actions############################# - Percent of Time - Repetitive use of foot control:################################### 00%### Repetitive use of hands:########################################## 100%## Grasping - simple/light:############################################ 80%## Grasping - firm/heavy:############################################# 15%## Fine dexterity:######## 99% ##Job Summary:Responsible for the accuracy of medical record documentation, including but not limited to: billing review to assess appropriate capturing of charges based on medical record documentation, review of dictated and hand-written entries in medical record to assess for compliance with regulatory and accrediting agencies, coordinating the CHA patient population discharge data program, coordinating payer audits, and assisting with medical record functions as necessary.ESSENTIAL JOB DUTIES Reviews billing records in comparison with medical record documentationTrends and reports results of charge capture reviews for department/administration actionReviews medical record documentation for compliance with regulatory and accreditation requirementsTrends and reports results of medical record reviews for medical staff actionPrepares monthly discharge data for reporting to CHASERVICE EXCELLENCE/CUSTOMER SERVICEDemonstrates purposeful service excellence through exceeding patient and coworker expectations.Represents the department/hospital as a dedicated, courteous, and responsive employeeCOMPLIANCE WITH RULES, REGULATIONS AND POLICIESRecords pertinent documentation in accordance with regulatory requirements, professional standards and hospital policy.Adheres to federal, state and hospital rules and regulations concerning HIPAA privacy and security.Follows Hospital compliance plan and policies, including the Code of Conduct.Participates in required training for compliance related activities (HIPAA, Compliance, Patient Safety, TJC, etc.)UNIT SPECIFIC DUTIES & RESPONSIBILITIES / DAY TO DAY OPERATIONSReviews patient account charges in comparison with medical record documentation to determine if charges are substantiated, within bill drop/hold time requirements.Trends and prepares monthly reports of review results, distributes to department directors and Compliance Committee members, and assists department directors in understanding those trends.Receives and responds to payor requested audits; prepares discrepancy or agreement paperwork based on results of said audits for payor and CFO.Prepares and submits monthly discharge data for reporting to CHA; edits incorrect or missing information as neededReviews medical record documentation for compliance with regulatory and accrediting agency requirements, including but not limited to:- timeliness of documents (History and Physical, Discharge Summary, Consults)- completeness of documents (all elements required are met)- legibility of documentationPrepares monthly reports of said reviews for medical staff actionPROFESSIONALISMDemonstrates responsibility and accountability for own professional decision making and professional growth.Participates and contributes to departmental meetings and activities.POPULATION SPECIFIC CRITERIADemonstrates the ability to assess and interact with customers of all ages, recognizing language and learning barriers, and technology challenges.Able to state his/her duties during a code pink drill.CORE VALUESPatient Centered:is passionate about patient care, creating positive impressions on a consistent basis and exceeding our patients expectations. Exhibits courtesy and sensitivity to the needs of patients and their families, responds with a sense of urgency to patient problems, anticipates patient requirements, responds proactively and places the patient s safety above all else.Teamwork:works collaboratively with physicians and other staff and assists whenever possible. He/she openly shares information, provides feedback and participates in appropriate decision making as part of a team of healthcare professionals. Hospital and departmental objectives are placed ahead of individual agendasRespect for Others:actively listens to others, takes other opinions into account, and communicates openly and honestly. He/she demonstrates respect for others by being timely with communications, completion of tasks, and meeting attendance. The employee is respectful of all physicians, colleagues, patients, visitors, and other stakeholdersAccountability:takes responsibility for his/her actions, abides by the hospital's guiding philosophies and policies, and follows through on commitments and physician orders. He/she provides complete and accurate information to the Physician and/or other members of the work team. takes personal pride and ownership in the quality of care and services provided to all internal and external customersIntegrity:is truthful, trustworthy, and principled. He/she demonstrates character, conviction, and honest and ethical behavior in all interactions with others. The employee's word can be trusted. Behavior is consistent with these AVH Core ValuesKNOWLEDGE, SKILLS & ABILITIESEDUCATION/EXPERIENCE REQUIREMENTSHigh School Grade or GED equivalent2 years experience in data quality position in acute care hospital2 years experience in billing, claims, payor relations for hospitalsLICENSE/REGISTRATION/CERTIFICATIONSRHIT/RHIA certification, preferredCMAS certification, preferredKNOWLEDGE AND SKILL REQUIREMENTSAbility to concentrate and show attention to detailRelatively high degree of analytical abilitiesStrong interpersonal skills requiredAbility to work independentlyMedical TerminologyAnatomy and PhysiologyPathology and Disease ProcessKnowledge of chargemaster, billing processes, payor relations, standards of documentation, and coding assignment.LANGUAGE SKILLSAbility to read and communicate effectively in EnglishSpanish preferredWORKING CONDITIONSNormal patient care environment with little exposure to excessive noise, dust and temperatureMay be exposed to communicable diseases through normal or careless performance of responsibilitiesMay be exposed to mechanical dangers associated with mechanical devicesMay be exposed to stressful situationsDESCRIPTION OF PHYSICAL DEMANDSPHYSICAL DEMANDSOn-the-job time is spent in the following physical activities. - Percent of Time-Stand: 10%Walk: 10%Sit: 80%Talk or hear: 99%Use hands to finger, handle or feel: 100%Push or pull: 10%Stoop, kneel, crouch or crawl: 10%Reach with hands and arms: 10%Taste or smell: 00%This job requires that weight be lifted or force be exerted. - Yes/ No -Up to 10 pounds: yes Up to 25 pounds: yes Up to 50 pounds: no Up to 100 pounds: no More than 100 pounds: no This job has vision requirements as follows: - Yes/No-Clear close vision: yes Clear distance vision: yes Depth perception: yes Three-dimensional vision; ability to judgedistances and spatial relationships: yes Ability to adjust eye to bring an object intosharp focus: yes WORK ENVIRONMENTJob may have exposure to the following environmental conditions: -Yes/No -Wet, humid conditions (non-weather): no Work near moving mechanical parts: no Fumes or airborne particles: no Toxic or caustic chemicals: no Outdoor weather conditions: no Extreme cold (non-weather): no Extreme heat (non-weather): no Risk of electrical shock: no Work with explosives: no Risk of radiation: no Vibration: no Hearing ability required for work environment is: - Yes/No -Ability to hear alarms on equipment: yes Ability to hear patient call: no Ability to hear instructions clearly: yes - Hi/Med/Lo -The typical noise level for the work environment is: low Repetitive Motion Actions - Percent of Time -Repetitive use of foot control: 00% Repetitive use of hands: 100% Grasping - simple/light: 80% Grasping - firm/heavy: 15% Fine dexterity: 99%

Keywords: Aspen Valley Hospital, Snowmass , Data Quality Specialist, Other , Snowmass, Colorado

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