Requests medical documentation and assures that documentation received meets insurance payer guidelines. Responds accurately and timely to any audits received.
ESSENTIAL JOB FUNCTIONS:
1. Documents activities in Enterprise Resource Planning (ERP) system in an efficient accurate and timely manner.
2. Logs and reports all received audit inquiries including: a. Prepayment audits/development letters b. Post payments requests for documentation c. Overpayment refund requests d. Medical necessity documentation requests and cert audits e. Billing/coding audits f. Full scale random sampling audits
3. Gathers and collates all existing documentation required: i.e Proof of Delivery, billing forms, signature attestations, signature authorizations and assignment of benefit documentation, letters of medical necessity, patient logs, etc...
4. Reviews all documentation to be submitted for audit purposes for completeness and accuracy.
5. Works with billing and collection teams to assure timely submission of all appeals.
6. Tracks and reports audit findings and results.
7. Evaluates and secures the needed prescriptions, prior authorizations and medical justification to facilitate initial payment of claims and review appeals/payments.
8. Prepares and reviews cleans claims for submission to various insurances either electronically or by paper.
9. Provides feedback to Group Team Leader regarding issues regarding accounts.
10. Conducts routine tasks as directed; works under clearly defined guidelines.
SUPPLEMENTAL JOB FUNCTIONS:
1. Performs additional duties as directed.
EDUCATION & EXPERIENCE REQUIRED:
- High School Diploma required; Associate s Degree preferred
- One or more years of experience in medical reimbursement
KNOWLEDGE SKILLS & ABILITIES:
- Proficient in Microsoft Office particularly Word, Excel & Outlook
- Must possess excellent communication skills and the ability to practice proper phone and email etiquette
- Skilled in answering a telephone in a pleasant and helpful manner
- Ability to read, understand and follow oral and written instructions
- Proficient with medical terminology and insurances HCPC/ICD-9 codes
- Familiar with home medical supplies prescription requirements for Medicare, Medicaid and Managed Care
- Strong knowledge of Medicare, Medicaid and Managed Care guidelines
- Background of medical terminology including various coding systems (ICD-9, CPT, HCPCS, NDC)
- Must be able to travel up to 10% of the time
How To Apply
Amount of Travel No Travel