Summary: Review denials received from Insurance based on LCD/NCD Guidelines, coding rules, medical necessity and work accounts receivables as assigned for accurate, timely, and proper reimbursement.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Follow up on claims from submission through final resolution.
- A/R work in task manager calling insurance companies and/or utilize website.
- Utilize Ecommerce to check to see if insurance company received electronic claim.
- Systematically work through A/R queue in task manager to make sure that the claim has been received by the insurance carriers and are paid in a timely manner.
- Prepare/submit medical claims electronically (when applicable by paper) to governmental, private pay, and commercial insurance carriers.
- Identify and resolve any claim delay issues that impact collections and report these issues to leadership
- Resolve account issues and credit balances.
- Follow up on payment errors, low reimbursement, denials.
- Accurately interpret Explanation of Payment (EOP).
- Initiate and track appeals as necessary.
- Resolve Coordination of Benefit (COB) discrepancies.
- Research denials utilizing task manager and appeal as necessary.
- Request medical records as needed.
- Verify insurance carrier current address.
- Utilize Coded Notes and task manager to document and track appeals, patient calls, etc.
- Attend meetings/functions specified by the Business Office Manager.
- Process patient account requests as needed.
- Demonstrate and exemplify behavior consistent with DaVita’s core values – service excellence, integrity, team, continuous improvement, accountability, fulfillment, fun.
- Maintain knowledge of company policies and procedures, OSHA and other related regulations and guidelines, and ensure department compliance.
- Attend and complete all required training and development to include annual compliance training by the required dates.
- Be the point of contact on the VEE Partnership in regards to AR Team training, Productivity and Quality Audits
- Work with Director to create SOPs
- Be point on weekly PIT calls with VEE – provide feedback to leadership in a timely manner.
- Perform additional duties as assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
High school diploma or general education degree (GED). At least 2-3 years previous medical insurance follow up.
Certificates, Licenses, Registrations:
Certified Professional Coder (CPC), Certified Coding Specialist (CCS) or Registered Health Information Technologist (RHIT) preferred
Basic computer knowledge and a typing speed of at least 30 wpm. Ability to learn and use effectively the DMG IDX computer system and coding assisting programs and reports.
Ability to read, analyze, and interpret coding periodicals, professional journals, technical procedures, or governmental regulations. Ability to write professional correspondence. Ability to effectively present information and respond to questions from providers, managers, and the general public. Must be able to speak clearly and concisely.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical information in mathematical or diagram form and deal with several abstract and concrete variables.
Must have basic computer knowledge and a typing speed of at least 30 wpm. Must be able to learn and use effectively the DMG IDX computer system.
Other Skills and Abilities:
- Ability to work with providers and nursing staff in a courteous and pleasant manner.
- Ability to work with a high level of speed and accuracy over long periods of time and stress.
- Ability to perform in an organized and efficient manner, demonstrating adaptability and flexibility.
- Ability to accept responsibility and take initiative to proceed without direct supervision.
- Knowledge of insurance rules and regulations preferred.
- Record of dependability in previous employment.
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. The employee is occasionally required to reach with hands and arms. Specific vision abilities required by this job include close vision for extended periods of computer work. Requires manual dexterity sufficient for use of a calculator and computer keyboard.
The work environment characteristics 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.
Work is performed in an office environment and involves frequent contact with staff. Workload may be demanding at times.