The Claims Review Coordinator will audit and provide support to Accounts Receivable functions by verifying completeness of clinical documentation that is required to ensure processing of clean Medicare claims.
MINIMUM JOB REQUIREMENTS
Education & Qualifications:
•Education: High School Diploma or equivalent required.
•Previous Experience: 2-3 years Home Health experience clinical and administrative experience preferred. McKesson Horizon Homecare experience with focus on Enter Services and Clinical Explorer. General understanding of billing processes, orders and clinical documentation preferred.
•Knowledge/Training: Strong attention to detail skills. Good interpersonal and communication skills with ability to cooperate with multiple departments at once. Working knowledge of office equipment and data entry systems. Ability to effectively communicate with internal and external customers. Ability to multi-task. Ability to meet daily deadlines. Ability to create education materials and present those in a professional manner. Strong clinical skills such as appropriate way to write orders, global understanding of clinical documentation. Demonstrates knowledge of regulatory requirements.
•Computer Skills: Must be familiar with general use and functions of the computer such as user names and password concepts; internet; e-mail; navigation of computer desktop or laptop including starting programs, using files and windows, effectively use navigation buttons and tool bars. Must be proficient in the basic Excel spreadsheet use. Horizon HomeCare skills preferred.
•Transportation: Reliable transportation required.
JOB SPECIFIC EXPECTATIONS:
•Audits the completeness of clinical documentation as related to the processing of Medicare claims to ensure clean claims.
•Coordinates the overall process of handling the billing audit tool related to Medicare claims
within the home health program and between all necessary departments.
•Complies and summarizes data regarding status of claims.
•Maintains appropriate clinical and financial reports to substantiate all activities to the processing of Medicare claims.
•Serves as a resource to program staff regarding issues relating to company policy, regulatory standards, billing
requirements and methods to accomplish compliance.
•Works with the home health program staff to formulate and evaluate standards for the processing of Medicare claims and physician orders.
•Keeps abreast of the latest information on quality and billing issues.
•Oversees the processing of Medicare claim checks and other on-line advisories on an ongoing basis.
•Complies with procedures established by the finance department regarding the processing of Medicare claims.
•Maintains knowledge of requirements and promotes compliance with all fiscal intermediary and/or third party payors.
•Demonstrates knowledge and understanding of the Medicare and Medicaid regulations, JCAHO standards and standards of care.
•Evaluates trends and makes recommendations for staff performance improvement based on data gathered from clinical records, claim check criteria and outcomes.
•Assists planning, development and implementation of performance improvement and financial activities, such as education of staff or process redesign as related to Medicare billing.
•Utilizes and practices the concepts of performance improvement in daily.
•Responds to requests made by the Performance Improvement Department for information processed by the claims check team.
•Provide Operations Managers with details regarding their outstanding items by team to include patient name, incomplete or missing documentation and action item to correct documentation for billing.
•Assist Education in creating modules or other training materials for the appropriate departments related to the underlying causes of the incomplete or missing documentation discovered in the audit.
Visiting Nurse Health System, Georgia’s largest nonprofit provider of healthcare and hospice at home, 64 year tradition of serving its mission of improving the lives of those we serve. Our vision is to set the standard for quality in Georgia and be the first place patients, families, payers and other healthcare providers select when in need of homecare or hospice services.
Each year Visiting Nurse Health System provides professional clinical and care management services to more than 25,000 patients in metropolitan Atlanta.
Visiting Nurse Health System is an EOE.
Visiting Nurse Health System - 20 months ago
Visiting Nurse is the leading provider of home healthcare and hospice care in Atlanta, Georgia, helping patients successfully manage their...