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Wilmington, DE 19806
Accountable for outcomes aligned with ROI and Audits (RAC, MAC, CMS, Initial chart requests for appeals, Compliance, third party, commercial, etc): workflow, accuracy, turn-around-time. According to established policies and procedures, participates in the APPEALS/DENIALS process. Understands and complies with PA Department of Health, HIPAA, and the Joint Commission regulations. Accountable for vendor performance: alignment with PA Department of Health, HIPAA, The Joint Commission, departmental and organizational policies & procedures, SMMC values, accuracy and turnaround time.
Oversees the processing of subpoena attorney, insurance, patient, military, patient, healthcare provider requests for patient information
Represents the Health Information Management Department in court and at dispositions involving subpoenas for medical records.
Processes all Search Warrants, Court Orders, and DA Subpoenas.
Receives and processes requests submitted via the SMMC website.
Provides personalized assistance to patients who wish to enroll in the HIE (Health Information Exchange): MyHealth Patient Portal.
Job Specific Competencies
2-3 yrs. Health Information Management Acute Care experience preferred
Upholds and promotes the operational philosophy and mission of CHE Trinity, the Core Values Program, and Values in Practice Standards of Performance
Performs all duties according to established policies and procedures.
Understands and complies with PA Department of Health, HIPAA, and The Joint Commission regulations
Coordinates HIM activity for RAC audit requests according to policy and procedure with 100% accuracy:
- Updates / completes tasks in the Veracity System according the RAC processing timeline
- Reviews patient record to ensure that all documentation is present in the chart and labeled correctly
- Obtains “missing” documentation
- Scans the most current Emergency Room documentation from IBEX, UBs, bills, EHR / Medical Necessity letter into the ImageWorks System. Burns the records to CD and labels the CDs as directed by the RAC
- Uploads the charts and other RAC documentation into the Veracity system
- Three days prior to the due date FEDEXs records to the RAC as 2 BUSINESS DAY delivery
- Verifies RAC receipt of the records via the FED EX website the day after the records are sent
- Updates completion of each task in Veracity, including RACS received
- Highlights/flags the requested charts in ImageWorks
Coordinates all insurance audits: Medicare, commercial, and third-party.
- Evaluates the audit requests, obtains the Scope of the audit from the auditing company, obtains non-clinical documentation: bills, and Care Management, as requested
- Creates a work list in ImageWorks Reviews patient record to ensure that all documentation is present and labeled correctly
- Obtains copies of bills when requested
- Verifies proper authorization and need for special authorization
- Works directly with auditor, answering any questions and making copies of requested information
- Obtains “missing” documentation
- Scans ancillary documentation as necessary and scans into the ImageWorks System
- Schedules the audits
- Communicates hospital and department polices as they relate to hours of operation, attire, parking, smoking, fragrance-free, duplication of documentation.
Oversees the processing of subpoena attorney, insurance, patient, military, patient, healthcare provider requests for patient information:
- Receives incoming mail:
- Reviews legal requests -
- Flags potential litigation that may involve SMMC
- Notifies Risk Management and HIM Management
- If chart is incomplete, notifies provider to complete chart
- Determines who should process requests: onsite or remote
- Forwards requests as appropriate
- Routinely assesses the work environment to ensure requests are processed timely
- Inquires with vendor colleagues as to current state and offers assistance to ensure no backlog.
- Provides coverage to the front window, phones, mail, etc, as necessary.
- As necessary provides backup to vendor:
- Reviews requests to determine validity, appropriateness and HIPAA and/or PA State regulations.
- Returns documents that are not HIPAA compliant.
- Gathers information. Reviews chart for completion. Notifies Physician Specialist and/or provider, as appropriate, when charts need to be completed prior to release
- Releases all information pertinent to the patient’s immediate need and follow up care.
- Obtains photo ID for verification of identity (for walk ins)
- Answers telephone requests from physicians or hospitals on an emergency basis; obtaining their name and phone number, then returning their call and relaying the requested information to them; completes the telephone release of information form for the release of information.
- Contacts patients directly when requested or subpoenaed records require special authorization for release of protected health information: drugs, alcohol, psychiatric, or HIV/AIDS.
Represents the Health Information Management Department in court and at dispositions involving subpoenas for medical records. Court order when a subpoena is not acceptable for release of information (ie: drugs, alcohol, psychiatric, or HIV/AIDS information appears on the record)
Court Orders & Search Warrants: Reviews court order or search warrant to determine validity, and HIPAA and/or PA State regulations. Contacts the District Attorney, court clerk or attorney to verify information requested and confirm date of appearance. If agreeable with issuing party, arranges to answer subpoena by mail following all legal steps in accordance with Act 145 legislation.
Providespersonalized assistance to patients who wish to enroll in the HIE (Health Information Exchange): MyHealth Patient Portal. Using the approved scripting, communicates the purpose and benefits of the HIE. As backup to Secretary, assists patients with enrollment and 1st time access to the MyHealth Patient Portal. Escalates all issues to the appropriate person/area.
Facilitates patient requests for Amendments: forwards completed Request for Amendments to Compliance for review and determination of acceptance/denial along with the provider names whose documentation is being disputed; upon receipt from Compliance, scans all documents into ImageWorks.
Communicates all issues and potential issues to department management as they arise. Follows-up until issue is resolved or deemed closed.
We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to 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.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Job Number: 00149107
Location: Wilmington, DE
Organization Name: Saint Francis Healthcare
Facility: SFDE – St. Francis Healthcare Service
Employment Type: Full time
Shift: Day Shift