Essential Duties and Responsibilities include the following. Other duties may be assigned.
- The Intake Specialist is an integral member of the reimbursement team and has primary responsibility for the timely clearance of new referrals (medical orders) from Lifecor field sales representatives and physician offices.
- This position is also responsible for billing the initial claim to the primary (and secondary, if applicable) insurance carrier for payment, along with the creation of the patient chart.
- Additional responsibilities include the submission of and participation in telephone hearings and ALJ appeals for all Medicare denials.
- Contact insurance companies to verify benefits for services and communicate results to patient and sales.
- Communicate medical need and educate case manager on LifeVest system to obtain authorization for services.
- Negotiate favorable rates with insurance carriers with guarantee of assignment of benefits, and complete fee calculator for billing.
- Obtain necessary documentation (medical order, clinical notes, patient agreement, etc.), determine medical criteria eligibility, and submit to insurance carrier for coverage determination.
- Assist team members with clinical interpretation of patient’s record during re-authorization process.
- Contact client, physician office, and sales representative to relay and/or obtain pertinent information and/or documents to effect clearance of new referrals.
- Create patient record in SoftAid; create reimbursement chart; create initial claim and submit to insurance carrier.
- May need to assist in maintaining spreadsheet of hearings and ALJ requests; submit request along with supporting documentation to CMS; track requests; follow-up with CMS on requests that have not been scheduled; prepare files for hearings and ALJ meetings, and participate in those meetings.
This job has no supervisory responsibilities.
To perform the job successfully, an individual should demonstrate the following competencies:
Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully.
Judgement - Exhibits sound and accurate judgment.
Planning/Organizing - Uses time efficiently.
Qualifications 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.
- Strong negotiation skills and experience working with all payer types to include Medicare, Medicaid, and third party commercial insurance companies.
- Superior communication and customer service skills and the ability to handle multiple tasks simultaneously under strict deadlines.
- Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
- 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.
Education and/or Experience
- 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.
- To perform this job successfully, an individual should have knowledge of Internet Explorer and MS Office Suite.
Certificates, Licenses, Registrations
Physical Demands 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 and use hands to finger, handle, or feel. The employee must occasionally lift and/or move up to 25 pounds.
Work Environment 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.
The noise level in the work environment is usually quiet
ZOLL is an Equal Opportunity Employer.
- H.S. Diploma or equivalent required, Associate’s or Bachelor’s degree in nursing, business, finance or related field preferred
- 3-5 years experience in medical billing and insurance verification.
- Experience in provider appeals with all payer types.