Medical Chart Review Specialist

Under supervision of the Director of Diagnostic Imaging obtains authorizations for procedures performs audits for
Radiology billing and checks insurance eligibility per protocol. Performs any combination of the following duties as
assigned by the director. Works closely with the Special Procedures Analyst and works collaboratively with Health
Information Management Business Services Radiologists Auditing and Compliance to ensure billing
authorizations and insurance eligibility are performed per protocol/policy/regulations. Ensures that job tasks are done
correctly and in a timely manner. Ensures that staff is kept informed on eligibility authorizations and billing issues
as needed.

This is specific to the cardiac cath lab and cardiology service line including electrophysiology Interventional radiology and structural heart interventional procedures in addition to the non-invasive imaging chages.

1. Actively participates in auditing Imaging Services through medical chart audits correlating medical
   documentation and patient charges.
   2. Maintains working knowledge of current billing methods policies and procedures in Imaging Department cost
   centers.
   3. Consults with Department Management and available resources to gather information relevant to work practices
   and functions.
   4. Seeks guidance and direction in problem solving when appropriate and assists in resolving problems.
   5. Identifies and reports to department supervisor areas of concern identified during work activities.
   6. Promotes interdepartmental communications by participation in committee or group activities as appropriate or
   requested.
   7. Remains abreast of current procedures through attendance at in-services and interaction with peers.
   8. Participates in and provides clerical support for performance improvement activities; compiles statistical reports.
   9. Maintains confidentiality of medical record and all related information.
   10. Supports and upholds Hospital policies procedures Rules and Regulations TJC State and Federal requirements.
   11. Maintains a pleasant courteous personality with the ability to act as a public relations agent between the Hospital
   and outside agencies.
   12. Ensures that persons who work for are served by or are associated with the Hospital receive the highest degree
   of attention and courtesy possible by personally complying with the hospitals STAR values.
   13. Utilizes Hospital Information System in audit and departmental processes.
   14. Coordinates with Internal Audit and Compliance Department Clinical Review Specialist for performing chart
   review and billing related activities.
   15. Runs eligibility through module in HIS or other insurance website and follows up on any items that do not meet
   eligibility to ensure patients are aware of insurance status prior to appointment.
   16. Obtains insurance authorization for procedures as requested.
   17. Obtains education in order to stay current on billing changes.
   18. Performs other related duties as required

1. Education: High school diploma or GED required.
2. Licensure: Radiology Certified coder (RCC) or Radiology Certified Coder Interventional (RCCI) preferred.
3. Experience: Previous experience with coding/billing issues for radiology compliance issues for various
Radiology codes preferred. Previous experience with obtaining insurance authorization and insurance
eligibility preferred