The Release of Information (ROI) Specialist Senior must ensure that every ROI is in compliance with the request, authorization, company policy, and federal (HIPAA) and state regulatory requirements. The ROI Specialist Senior is responsible for the processing of all types of ROI requests, especially those level 2 high liability requestors which include the surgery care center, itemized billing, short/long term disability, patient, appeal/denial, employer, insurance, internal legal and risk management, attorney/legal and workman's comp in a timely and efficient manner ensuring accuracy and providing customers with the highest quality product and customer service. This position must provide exceptional customer service to patients/customers requesting a release of health information in situations that often require tight turnaround times, higher expectations and involve concerns with billing. The specialist must complete release of information requests including retrieving the patient's medical charts in Epic, copying/scanning/e-delivery of medical records accurately and correctly, according to established procedures and standards of quality. The specialist is responsible for completing a 10 point verification process to help avoid breeches and possible legal actions. This senior position will also act as a mentor and resource to the less experienced ROI specialists. This position is also responsible for Cancer Reporting to the state registry by reviewing medical records for cancer details, releasing pertinent information into the state cancer registry website as well as documenting the release in Epic.
1. Sort, prioritize, prepare, input and respond to all incoming documents via phone/fax/email/mail for ROI requests utilizing the ROI module in Epic.
2. Review and process requests for ROI in compliance with HIPAA and established protocols. Responsible for level 2 high liability requests including: surgery care center, itemized billing, short/long term disability, patient, appeal/denial, employer, insurance, internal legal and risk management, attorney/legal and workman's comp ROI requests.
3. Retrieve records in response to requests for information while reviewing records for appropriate dates of service, verification of identity, and specific content requested. Might have to gather health information from multiple sources.
4. Obtain guidance from the ROI supervisor and Health Information manager as needed. Help provide training and mentoring to less experienced Release of information specialists.
5. Communicate with attorneys, law enforcement, auditors, and insurance company representatives as well as a variety of other professionals regarding issues with payments, getting records, expediting requests and help getting authorizations as well as managing any complaints or concerns.
6. Interact with physicians and staff when requesting Visual Fields, OCT's and other test results that are not in EPIC from the eye department as well as Psych department and physicians when needing Psych approvals. Work with the disability and radiology departments as needed.
7. Provide patients assistance in completing authorization forms, guiding them on the process of ROI and completing their requests with high patient satisfaction.
8. In ROI module prepare invoices and collect payments for services provided. Review invoice sections of ROI to confirm appropriate billing or no charge before completing the request. Follow established protocols for receiving payment and processing through accounting.
9. Performs quality checks on all work to assure accuracy of the release, confidentiality and proper invoicing. Perform 3 step Quality Assurance (QA) by validating appropriate information on the authorization/request during intake, processing and completion. Must confirm patient identifiers, information to be released, time frame, requestor information and provide the" minimum necessary" is released in order to avoid breeches and possible legal actions.
10. Demonstrate helpful and effective telephone etiquette and customer service skills by providing appropriate information to callers. Ability to calmly deal with customers in stressful and escalating situations.
11. Responsible for cancer reporting by reviewing medical records for cancer details and then releasing pertinent information into the state cancer registry website. Create Epic FYI flags for tracking reportable vs non-reportable data for accounting and disclosures. Receive additional training as necessary from the state to stay current on cancer reporting requirements.
12. Determine reportability of cancer cases using SEER guidelines. View patient record in Epic and extract pertinent information regarding reportable types of cancer and submit into a reporting form to the state registry. Must be able to determine which information is pertinent to each type of cancer and submit complete cases to the state of Wisconsin.
13. Performs other duties as assigned.
1. High school diploma or equivalent.
2. Minimum of 3 years of experience navigating health records in a healthcare setting or related records administration of which 1 year is working with ROI specifically.
3. Past work experience using Epic or other Electronic Medical Record software.
4. Experience working with confidential information, information security and use of ethical behavior when handling all information. Experience in a situation where consequences of oversight or error could result in financial or legal action.
5. Basic computer and keyboarding skills. Proficient in the use of printers, scanners, fax machines and copy machines.
6. Exceptional customer service skills and ability to interact with patients/customers in stressful situations.
7. Excellent communication skills, both verbal and written. Able to communicate effectively with providers, clinical staff, patients, insurance companies, lawyers, government agencies and various employers.
8. Demonstrated ability to multitask and feel comfortable with deadlines and changing priorities.
9. Demonstrated ability to work within established procedures with a little degree of supervision.
10. Strong attention to detail and critical thinking skills.
11. Problem solving skills including the ability to define problems, collect data, interpret data, facts, and draw conclusions.
12. Good interpersonal and teamwork skills.
1. Associates in a Healthcare related field and/or a Registered Health Information Technician (RHIT) Certification
2. Experience working in a position with stringent rules and procedures when processing information.
3. Past work experience with the state Cancer Registry.
4. Knowledge of the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute website.
5. Ability to perform own research.
6. Medical terminology related to specific cancer types.
7. Proficient in MS office applications.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. This is a predominantly sedentary position.
2. Ability to continuously see fine print and use the computer.
3. Ability to hear and converse on the phone and in person.
4. Ability to perform fine motor tasks, such as pulling charts, filing paper, writing, computer or phone tasks.
5. Ability to safely lift and push/pull boxes or charts of medical records weighing up to 20 pounds.
About SSM Health Dean Clinic-
Based in Madison, Wis., Dean Clinic consists of a network of more than 60 clinics in south-central Wisconsin. Our more than 500 physicians provide primary, specialty and tertiary care in the clinics as well as eye care through our Davis Duehr Dean locations. Dean Clinic also offers urgent care services and operates outpatient surgery centers. Dean Clinic joined SSM Health in 2013.
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your fa...mily and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same