Coding & Benefits Specialist

Title: Coding & Benefits Specialist

Location: In-Office Position in Jefferson.

Position Type: Full Time, 1.0 FTE, Hourly, 40 Hours/Week

Be the Difference!

Make a meaningful impact in the lives of others. Rainbow Community Care is highly regarded for excellence in hospice, palliative, and guided care and invites you to join in our mission of enhancing lives throughout aging, illness, and loss.

Purpose of the Position

Responsible for being a member of the quality and compliance team.  Completes benefit verifications and pre-authorizations as necessary.  Documents diagnosis codes based on record review and in collaboration with ARNPs/hospice physicians, and in accordance with coding guidelines on admission and ongoing. Maintaining accurate medical records for Hospice and Palliative Care patients.

Key Responsibilities

• Reviews records for payor, external agencies, diagnosis, and pertinent demographic information and communicates to the team.
• Assists as directed in the hospice and palliative care referral and intake process.
• Verifies insurance coverage and benefits and obtains prior authorization as needed.
• Verifies hospice certification period via NGS Connex and determines any needs for face-to-face visits prior to admission.
• Documents and communicates payor information to IDT.
• Reviews Medicare secondary payor screen for verification of coverage priority.
• Facilitates diagnosis coding on admission and ongoing for all patients in collaboration with ARNP and/or hospice physician consistent with regulations and coding guidelines.
• Facilitates ongoing communication with IDT regarding primary diagnosis and secondary diagnoses.
• Maintains accurate diagnosis coding in the electronic medical record and makes necessary changes or corrections.
• Documents appropriate information in the medical record in a timely manner.
• Obtains records for physician office visits, diagnostics, and procedures to review for coding purposes, eligibility, and as requested.
• Maintains files of necessary patient records in both paper and electronic formats according to state and federal law.
• Works closely with HIPAA Privacy and Security officials to identify risk areas and maintain compliance with HIPAA policy and procedures.
• Other duties as assigned.

Professional Qualifications

• High school diploma or equivalent.
• Minimum of 1 years’ experience in hospice or health care preferred. Demonstrated knowledge of medical terminology preferred.
• Minimum of 1 years’ experience in Medical Coding, certification, or willing to obtain preferred.
• Understanding of the Medicare Hospice Benefit.
• Demonstrated ability to perform detailed work in a timely manner with accuracy and thoroughness.
• Responds to unclear or difficult situations with appropriate and independent problem-solving techniques.
• Demonstrated ability to respond well to supervision and to work independently when appropriate.
• Demonstrates excellence with communication skills and ability to work well in a team environment.
• Excellent computer skills.
• Demonstrates flexibility in work schedules and functions as a team player.
• Adheres to RCC’s Corporate Compliance Plan
• Abides by all RCC’s medical record and confidentiality policies and procedures.
• Abides by all HIPAA security and privacy policy and procedures.

Personal Qualifications

• Affirms the knowledge, philosophy, and principles of hospice care.
• Maintains patient confidentiality.
• Always presents self in a professional manner.
• Excellent customer services skills.
• Inspires a culture of trust and team morale, acts with integrity, and demonstrates good work ethics including good attendance and punctuality.
• Able to maintain healthy boundaries.
• Directs and promptly applies problem-solving techniques in resolving issues.
• Applies best practices as stewards of patient’s financial resources.

Working Conditions

• Physical Requirements: Able to sit for extended periods of time; manual dexterity to operate computer and other office equipment.
• Mental Requirements: Read, speak, write and understand English. At times must function independently without supervision while working in collaboration with the IDT.
• Working/Environmental Conditions: Fast-paced changing environment, with multiple directives from several disciplines.

Benefits

• Flexible, fun, and caring work environment
• 401k Retirement Plan with up to 4% Company Match
• Health & Dental Insurance
• Vision Insurance
• Flexible Spending & Health Savings Accounts
• 100% Company-Paid Group Life Insurance
• 100% Company-Paid Short-Term & Long-Term Disability Insurance
• Generous Paid Time Off & Paid Holidays
• Mileage Reimbursement
• Tuition Reimbursement
• Pet Insurance

About Rainbow Community Care

Rainbow Community Care provides services that support patients, families, and community members throughout the journey of aging, illness, and loss. Guiding our day-to-day work is a set of core values that are centered around caring for the most vulnerable people living among us.

• We are committed to serving all.
• We are relentless in our pursuit of excellence.
• We believe every interaction matters.
• We are leaders.
• We always show up.

Equal Opportunity Employer Statement

Rainbow Community Care is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.