Qualifications: Must have good computer skills, accurate data entry skills, working knowledge of the Condor order entry system; and good organizational skills. Upon completion of training, must have a thorough understanding of documentation needed for claims submission. Education: High school diploma or equivalent.
Primary Purpose of Position: Obtain necessary documentation for claims submission.
Essential Duties & Responsibilities: Essential duties and responsibilities include the following. Other duties may be assigned.
- Generate necessary documentation to be sent to physician for completion.
- Obtain documentation from physician if not received with order for services.
- Review all documentation received ensuring it meets all criteria for medical billing. If not complete, return to physician for completion.
- Validate documents in Condor Scripts Que, checking to make sure all changes are added as observed on document.
- Determine whether patient meets criteria for over-quantity of supplies in accordance with payer criteria (i.e. Logs, letter from doctor, copies of patient records, etc.)
- Follow up on documentation not received in a timely manner. If documentation is not received, transfer file to manager for action and keep weekly spreadsheet current.
- Review electronic image in Condor Scripts Que on a daily basis, enter prescriptions, logs, sleep studies, etc., as received in Condor in the E-doc Que. Send notes through Condor to appropriate staff regar regarding document.
- Review Go Jasec documents, validate electronic document in Condor.
- Review reports, such as 3rd requests, DMERC requests, BCBS time-sensitive requests.
- Additional tasks as assigned.
