Quality Reviewer
Radiation Oncology
Full Time
Day Shift
8
Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bed teaching hospital in West Columbia, South Carolina. It was selected by Modern Healthcare as one of the Best Places to Work in Healthcare and was first in the state to achieve Magnet with Distinction status for excellence in nursing care. Consistently ranked as best in the Columbia Metro area by U.S. News & World Report, Lexington Health delivers more than 4,000 babies each year, performs more than 34,000 surgeries annually and is the region's third largest employer.
Lexington Health also includes an accredited Cancer Center of Excellence, the state’s first HeartCARE Center, the largest skilled nursing facility in the Carolinas, and an Alzheimer’s care center. Its postgraduate medical education programs include family medicine and transitional year residencies, as well as an informatics fellowship.
Job Summary
The Quality Reviewer works closely with the Radiation Therapist, and carries out audits and reconciliation on accounts, charges, and chart documentation on all Radiation Oncology patients. This role ensures accounts are accurate and are prepared for final billing in a timely manner with Corporate Compliance. The Quality Reviewer ensures diagnostic codes are entered correctly in all systems of record; including ARIA and EPIC. The Quality Reviewer creates reports of department data for statistical trending and evaluation of services.
Minimum Qualifications
Minimum Education: High School Diploma or Equivalent
Minimum Years of Experience: 3 years working in medical billing, coding, and/or insurance
Substitutable Education & Experience: Associate Degree with 1 year relevant experience.
Required Certifications/Licensure: N/A
Required Training: Functional knowledge of computers and Microsoft products (Word, Excel, Outlook etc.). Procedural knowledge of medical terminology, ICD10, and CPT coding.
Essential Functions
Audits charts initially, daily, and at completion of treatment for billing, charting, and documentation accuracy and thoroughness.
Collaborates with Administrative Assistants and Professional Billers to ensure registration and authorization accuracy.
Works in both ARIA and EPIC to add diagnosis codes for consult and follow up appointments.
Informs supervisor and physicians when changes are needed based on CMS rules and insurance guidelines.
Collaborates with clinical and technical staff for positive and negative trends.
Duties & Responsibilities
Works with Director to improve patient satisfaction and eliminate barriers to quality care.
Collaborate with other hospital departments (Accounting, Coding, Insurance, Medical Records, Patient Financial Services) to create timely billing and eliminate payment denials.
Collaborates with Director and other staff to maintain up-to-date hospital chargemaster, staying current with latest CPT rules and reimbursement issues.
Tracks and trends monthly and yearly statistical data for Accounting, LMC Administration, and DHEC.
Discharges all HRON (Radiation Oncology) accounts after completion and chart close out.
Performs all other duties as assigned.
We are committed to offering quality, cost-effective benefits choices for our employees and their families:
- Day ONE medical, dental and life insurance benefits
- Health care and dependent care flexible spending accounts (FSAs)
- Employees are eligible for enrollment into the 403(b) match plan day one. LHI matches dollar for dollar up to 6%.
- Employer paid life insurance – equal to 1x salary
- Employee may elect supplemental life insurance with low cost premiums up to 3x salary
- Adoption assistance
- LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
- Tuition reimbursement
- Student loan forgiveness
Equal Opportunity Employer
It is the policy of Lexington Health to provide equal opportunity of employment for all individuals, and to remain compliant with applicable state and federal laws and regulations. Lexington Health strives to provide a discrimination-free environment, and to recruit, select, on-board, and employ all employees without regard to race, color, religion, sex, age, disability, national origin, veteran status, or pregnancy, childbirth, or related medical conditions, including but not limited to, lactation. Lexington Health endeavors to upgrade and promote employees from within the hospital where possible and consistent with the employee’s desires and abilities and the hospital’s needs.
Nearest Major Market: Columbia
Nearest Secondary Market: South Carolina