Description
Essential Functions and Job Responsibilities:
· Develop and maintain working knowledge of current HME products and services offered by the company.
· Review and manage patient eligibility documents such as prescriptions, certificates of medical necessity, letters of medical necessity and prior authorizations.
· Analyze documentation required for billing services and ensure compliance to payer requirements
· Review’s documentation to make sure it is valid prior to releasing to bill claims in order to ensure completeness and accuracy.
· Through daily work activities identifies trends, either system or process driven, that can be changed or modified to improve efficiency and create cost savings
· Accurately process, verify, and/or approve documentation to facilitate the release of claims to bill.
· Complete insurance verification to determine patient’s eligibility, coverage, co-insurances, and deductibles
· Must be able to navigate through multiple online EMR systems to obtain and or review applicable documentation
· Review and log all pertinent information in EMR system including initial authorizations, initial CMN and expiration dates
· Collaborates with AdaptHealth sales and support staff to ensure timely receipt of documentation.
· Communicate with leadership on an on-going basis regarding any noticed trends with insurance companies
· Verify insurance carriers are listed in the company’s database system, if not request the new carrier is entered
· Meet quality assurance requirements and other key performance metrics
· Maintain and review all required documentation for insurance coverage and reimbursement per insurance guidelines and company policy.
· Contact AdaptHealth operations teams, and centralized RCM teams, to obtain additional supporting medical necessity documents if warranted.
· Report to supervisor any apparent issues and coordinate submission of all required documentation.
· Assist with implementation of performance improvement program as it relates to billing and coding performance.
· Maintain patient confidentiality and function within the guidelines of HIPAA.
· Develop and maintain working knowledge of current HME products and services offered by the company.
· Completes assigned compliance training and other educational programs as required.
· Maintains compliant with AdaptHealth’s Compliance Program.
· Perform other related duties as assigned.
· Maintain regular, predictable, consistent attendance and flexibility to meet the needs of the department.
· Understand and follow all Medicare, Medicaid, HIPAA, and Private Insurance regulations and requirements.
· Plan and organize work effectively and ensure its completion.
· Meet all productivity requirements.
· Demonstrate team behavior and promote a team-oriented environment.
· Actively participate in continuous quality improvement.
· Always represent the organization professionally.
Competency, Skills and Abilities:
· Knowledge of Medicare, Medicaid, and commercial health plan reimbursement methodologies and documentation requirements.
· Excellent verbal and written communication skills.
· Well organized, detail oriented and possess strong problem-solving and critical thinking skills.
· Ability to prioritize tasks, manage multiple projects and work independently
· Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.
· Ability to read and interpret documents such as Medicare, Medicaid and commercial health plan policy articles and procedure manuals.
· Ability to prepare routine reports and correspondence.
· 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.
· Computer Skills: Strong proficiency in Microsoft Office: Excel, Word, Outlook
Requirements
Education and Experience Requirements:
· High School Diploma or equivalent
· One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.
· Senior level requires two (2) years of work-related experience and one (1) year of exact job experience.
· Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.
Physical Demands and Work Environment:
· Must be able to lift 30 pounds, stand, bend, stoop, and be able to sit at a computer for extended periods of time.
· Ability to perform repetitive movements of the upper extremity’s motions of wrists, hands, and/or fingers due to extensive computer use
· Work environment may be stressful at times, as overall office activities and work levels fluctuate
· Subject to long periods of sitting and exposure to computer screen
· Excellent ability to communicate both verbally and in writing
· Ability to utilize a personal computer and other office equipment