The rewards at Healogics are immense, starting with the important work we do to change patients' lives. We also understand that meaningful work is hard work, and we are committed to supporting and compensating our employees for the tremendous service they provide.
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Healogics is the largest provider of advanced wound care services in the United States, treating more than 300,000 chronic wound patients annually across over 600 sites. With an aging society, obesity and diabetes on the rise, and an uptick in surgical procedures, the number of patients with non-healing wounds that would benefit from expert care is dramatically increasing. As a result, the company is working to provide our differentiated, quality outcomes to as many patients that would benefit through our out-patient clinic partnerships.
The Medical Records Analyst & Educator is a member of HWCS' Healogics Documentation Team who works closely with outside vendors and / or customers as well as internal HWCS staff and employees of other Healogics entities. The duties and responsibilities of the Medical Records Analyst & Educator include analysis of medical records to support daily claims analysis and "scrubbing" of claims against relevant payor criteria for coverage. This includes Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) associated with Medicare and its Medicare Administrative Contractors (MACs) as well as coverage guidance provided by other governmental payors and private payor entities. The Medical Records Analyst & Educator is responsible for collection, validation, and analysis of patient information applicable to specific DME or other supply orders and referencing internal and external guidance material which identifies documentation necessary from the medical record for "scrubbing" of the claim associated with the order. The Medical Records Analyst & Educator is also responsible for reconciliation of "missing documentation" reports for claims under review and education of clinical staff and patient navigators with respect to why said information necessary for the review of a particular claim. From time to time, the Medical Records Analyst & Educator also will be required to compile data and otherwise assist in reporting and auditing related to activities of the Healogics Documentation Team.
Due to the requirement to routinely access medical records, this position requires a familiarity and compliance with the Health Insurance Portability and Accountability Act ("HIPAA") as well as similar state laws. This position requires a general familiarity with electronic medical record ("EMR") systems. Healogics has its own EMR system - i-heal. Training specific as to the use of this system will be provided.
This position requires familiarity a variety of coverage determination publications from governmental and private payors and maintaining familiarity as updated materials on such coverage determinations are published. In instances where guidance material is unclear or conflicting, the Medical Records Analyst & Educator must be able to interpret available material and provide a written opinion as to coverage based on facts related to a specific situation. A basic understanding of medical terminology and working familiarity with Medicare LCDs and NCDs is required. Training as to updated coverage determination materials and new payors with which the Medical Records Analyst & Educator are expected to be familiar will be provided.
The Medical Records Analyst & Educator will understand and fully support the mission, vision, and value statements of HWCS and the Healogics family of companies. The Medical Records Analyst & Educator contributes directly to the Healogics Key Result of "Grow the Business" by assisting in the process of efficient claims management and indirectly to the Healogics Key Result of "Exceptional Patient Experience" by ensuring that patient claims are handled promptly and accurately.
All HWCS employees must perform their job responsibilities according to all company policies, as well as hospital policies, policies of accrediting organizations, federal and state regulations, and guidelines of the Centers for Medicare and Medicaid Services (CMS), as applicable.
Essential Functions/Responsibilities
Review order packets for DME or supplies as compiled by the Medical Records Processor. Confirm relevant payor for the order. Confirm documentation provided is complete based on the requirements of the payor and DME / supply ordered.
Return incomplete order packets to the Medical Records Processor and identify what documentation is missing. As necessary, work with Medical Records Processor to contact and educate accounts regarding missing documentation. The Medical Records Analyst & Educator may be required to educate center-based staff when data required by a payor to process a DME / supply order is missing from documentation, i.e., progress notes or wound assessments missing data such as duration of need, quantity used per day, total quantity used, etc. The Medical Records Processor should engage in continued contact to ensure supplemental data or documentation is received once education has been provided.
Engage in formal and informal education to wound care center-based staff, including patient navigators, case manager, clinical nurse managers, and providers as to documentation and data necessary for review of DME / supply orders based on the coverage requirements of specific payors.
Analyze order packets based on the identified payor and their associated coverage determination guidance. Classify order packets as (i) clearly meets payor guidance as to medical necessity, (ii) based on reviewer's opinion, meets payor guidance as to medical necessity (with written opinion), (iii) clearly does not meet payor guidance as to medical necessity, or (iv) based on reviewer's opinion, does not meet payor guidance as to medical necessity.
For determinations in categories (ii) and (iv), meet with DME Documentation & Education Manager and / or other individuals within Healogics who have expertise as to payor coverage determinations and confer as to final position as to medical necessity based on the specific payor and DME / supply ordered. Ensure proper documentation of consensus opinion.
Upload and maintain collected analysis and determination documents in HWCS' Documentation Repository System.
Provide routine follow-up to wound care center-based staff to advise of metrics related to initial completeness of documentation for order packets received as well as validation rate for medical necessity requirements.
Assist with departmental audits as well as vendor or customer audits.
Follow all confidentiality and security requirements as to medical records.
Follow all documentation and tracking requirements related to records requests to allow for data analysis of program efficacy and efficiency.
Complete administrative duties including answering phones, taking messages, responding to emails, communicating information back to vendors / customers, maintaining necessary logs, and collaborating with fellow team members.
Participate in improving quality throughout the company and the Healogics organization.
Perform other duties as required.
Required Education, Experience And Credentials
Associates degree from an accredited university or college in business, accounting, finance, healthcare administration or related field or equivalent experience
Minimum of two (2) to four (4) years related experience in health care finance and/or revenue cycle in hospital, physician office or., other related setting.
Required Knowledge, Skills And Abilities
Working knowledge of DME coding, billing, payor requirements, and denial management.
Must have a working knowledge of the Medicare and MAC codes, rules, regulations, pronouncements and applicable Fiscal Intermediary polices (e.g. Local Coverage Determinations).
Familiarity with medical terminology.
Proficient in Microsoft Suite (Excel, Word, Outlook).
Keen attention to detail with the ability to work independently and maintain confidentiality.
Ability to collaborate and demonstrate leadership skills in a team environment.
Strong interpersonal, written and verbal communication skills with a focus on customer service.
Organization, prioritization and time management skills.
Working knowledge of systems/applications with indication of those preferred.
Demonstrated ability to exhibit integrity and commitment to professional ethics.
Budget and long-term planning skills.
The salary for this position generally ranges between $44,800.00 - $66,300.00 Annually
This range is an estimate, based on potential employee qualifications: education, experience, geography as well as operational needs and other considerations permitted by law.
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