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.
Qualifications:
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)
