SUMMARY: Supports the documentation department to ensure quality assurance and completes certificate of medical necessities to release claims for payment.
ESSENTIAL DUTIES AND RESPONSIBILITIES: Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.
- Reviews documentation to confirm qualifications for insurance guidelines have been met.
- Assists with unbilled report for applicable CMN holds – CMN Not Attached.
- Responsible for logging good/completed scripts for release of revenue.
- Update any patient information or diagnosis information as needed.
- Perform appropriate communication to ensure the doctor table within HDMS is maintain, updated and accurate.
- Work daily problem CMN’s that come back incomplete.
- Understanding and striving to meet or exceed department metrics, as well as continually tracking and taking ownership of all numbers that fall within the providership table.
- Maintain current knowledge on Medicare, Medicaid, and all third party payers for required prescription guidelines.
- Uphold positive attitude towards tasks and co-workers, as well as a commitment to teamwork throughout the documentation team and the organization.
- Implement changes as requested that affect A/R and audit compliance.
- Other duties as requested by Management.
SUPERVISORY RESPONSIBILITES
This position does not have any supervisory responsibilities.
QUALIFICATIONS
To perform this job successfully, an individual must be professional, proactive and positive with internal and external customers and coworkers. The requirements listed below are representative of the knowledge, skill, and/or ability required.
Education and/or Experience
- High school diploma or general education degree (GED).
- Minimum of six (6) months in a medical related field and/or training; or equivalent combination of education and experience.
Skills & Abilities
- Excellent interpersonal, written and verbal communication skills.
- Attention to detail
- Good data entry skills
- Proficiency with computers, with strong typing skills.
- Good organization skills
Language Skills English (verbal, written) Mathematical Skills
Ability to add, subtract, multiply, and divide in all units of measure using a calculator.
Analytical & Problem Solving Ability
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
CERTIFICATES, LICENSES, REGISTRATIONS
None
PHYSICAL DEMANDS
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.
While performing the duties of this job, the employee is regularly required to sit, talk and hear. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision. All employees are required to work in a safe manner.
WORK ENVIRONMENT
The work environment described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Office environment with moderate level noise.
TRAINING
Orientation and selected courses must be completed in the designated time frame.
ADDITIONAL QUALIFICATIONS
None
