Medical Record Analyst & Educator

About the role

The Medical Records Analyst & Educator plays a crucial role in the Healogics Documentation Team, supporting daily claims analysis and scrubbing of claims against relevant payor criteria for coverage. This position involves analyzing medical records, validating documentation, and educating staff and patients on necessary information.

Responsibilities

• Confirm relevant payor for the order and ensure 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 missing documentation.
• Contact and educate accounts regarding missing documentation.
• Educate wound care center-based staff, including patient navigators, case managers, clinical nurse managers, and providers, on 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, classifying order packets as meeting, exceeding, or not meeting payor guidance as to medical necessity.
• 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.
• Aid in departmental and vendor/customer audits.
• Follow all confidentiality and security requirements as to medical records.
• Perform 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.

Requirements

• 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.
• Working knowledge of DME coding, billing, payor requirements, and denial management.
• 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.

Qualifications

• Basic understanding of medical terminology and working familiarity with Medicare LCDs and NCDs.
• Ability to interpret available material and provide a written opinion as to coverage based on facts related to a specific situation.

Skills

• Working knowledge of systems/applications with indication of those preferred.
• Demonstrated ability to exhibit integrity and commitment to professional ethics.

Benefits

Healogics offers a comprehensive benefits package designed to support the diverse needs of our employees. This includes:

• Health insurance options
• Paid time off
• Retirement savings plans
• Flexible spending accounts
• Employee assistance programs

Pay

The hourly rate for this position generally ranges between $21.00-22.00 Per Hour. This range is an estimate, based on potential employee qualifications: education, experience, geography as well as operational needs and other considerations permitted by law.

Schedule

Hours are typically full-time, but may vary based on department needs.