Job description
At Bridgeport Hospital, we are committed to providing quality medical care and treatment that is coordinated and centered on the patient's specific needs. We strive to achieve benchmarks as a Patient Centered Medical Home and provide health care in a setting where patients are at the center of their care team. All employees of Bridgeport Hospital are part of the patients care team and contribute to the team approach of promoting access, continuous, comprehensive care and work to provide quality improvement in the care provided to their patients.
The Clinical Reimbursement Specialist is responsible and accountable for ensuring the reimbursement of patient care that efficiently and effectively support the desired financial and clinical outcomes. Review medical records for appropriateness and continued length of stay providing supporting documentation to payers to obtain authorizations. Responsible also to collect data on diagnosis and procedures as well as other clinical documentation to appeal payer decisions when necessary. In collaboration with the health care team, the Clinical Reimbursement Specialist ensures that specific financial outcomes are achieved and that processes are appropriately developed and utilized within the designated fiscal time frame to ensure payment. With other members of the health care team, the Clinical Reimbursement Specialist participates in the ongoing evaluation of payment practices, authorization review processes, and the identification of barriers and trends to such aspects of care coordination that support timely and appropriate reimbursement. Through this interaction, the team, and the Clinical Reimbursement Coordinator, work collaboratively toward resolution and process improvement.
EEO/AA/Disability/Veteran Responsibilities:
EDUCATION
Bachelors Degree in Psychology or Related Field
EXPERIENCE
A minimum of three years of relevant clinical experience strongly preferred in a psychiatric setting, along with relevant experience in case management, care coordination, and/or utilization management in a psychiatric or insurance setting. Knowledge of finance and billing practices are strongly preferred.
LICENSURE
License preferred
SPECIAL SKILLS
Clinical credibility with physicians, nurses, and other members of the health care team. Strong interpersonal skills to facilitate negotiation for reimbursement and changes in systems /practices. Excellent communication skills with the ability to communicate effectively with multiple clinical and financial disciplines and skill levels. Ability to quickly process problems, identify solutions, and implement action to support desired financial outcomes. Ability to provide financial education balancing clinical needs to colleagues and physicians. Comprehensive understanding in the use of computerized medical record systems to support review activity. Working knowledge of third party and governmental payor prospective payor systems. Comprehensive PC literacy with proficiency in Microsoft word, excel and powerpoint.
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