About this role
Duties:
• Review and understand Insurance policies and standard Explanation of Benefits.
• Review and understand medical documentation effectively.
• Review and resolve request for medical records, related to
• Claims processing
• Internal and external audits
• Authorized external entities
• Monitors & maintains audit logs.
• Performs internal audits for quality assurance.
• Responsible for managing medical records of patients for insurance, private individuals and/or Government entities for home medical equipment.
• Establishes and maintains effective communication and good working relationships with patients/family, physicians' offices, and other internal teams for the patient's benefit.
• Performs other clerical tasks as needed, such as
• Answering patient/Insurance calls
• Faxing and Emails
• Communicates appropriately and clearly to Manager/Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor
• Other responsibilities and projects as assigned.
Requirements:
• High School Diploma or equivalent
• Knowledge of Explanation of Benefits from insurance companies
• Working knowledge of government, regulatory billing and compliance regulations/policies for Medicare & Medicaid
• Working knowledge of CPT and ICD-10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits.
• Knowledge of policies and procedures to accurately answer questions from internal and external customers.
• Utilizes initiative while maintaining set levels of productivity with consistent accuracy.
Experience:
• Minimum of 2 Years in DME experience required
• 3-5 Years in DME or medical billing experience preferred
Skills:
• Superior organizational skills.
• Proficient in Microsoft Office, including Outlook, Word, and Excel.
• Attention to detail and accuracy.
• Effective/professional communication skills (written and oral)