The Home Care Delivered Documentation Review Associate is responsible for policy/procedure compliance, legal compliance, and quality assurance associated with all physician-generated and patient-generated services and claims documentation. He/She reviews incoming patient order-related documentation for completeness and correctness in order to ensure proper claims billing. The Associate speaks with physician office staff (and/or patients) when information provided is incomplete or incorrect. The mission of the Associate is to maintain 97% or greater accuracy rating each month. The ideal Documentation Review Associate has an Associates degree (or coursework leading to a degree), two years of relevant experience, strong computer/Internet skills, polished phone skills, an aptitude for math, and is highly collaborative.
The following is a representative list of the duties and responsibilities associated with this position:
-- Reviews returned documentation (such as Physician Orders and CMNs) to ensure that all necessary information is complete and correct for claims billing.
-- Makes outbound calls to physicians’ offices to update patient and/or physician information.
-- Maintains a 97% or better accuracy rating each month.
-- Updates system records as needed.
-- Expedites service in situations requiring urgent attention as determined by management.
-- Identifies opportunities for improvement and contributes to solutions to enhance workflow efficiency and enhance the customer’s experience.
-- Understands workflow processes of contiguous departments and uses knowledge to make effective processing decisions.
-- Works independently and/or collaboratively to expediently answer inquiries and resolve issues within regulatory and Company requirements to ensure customer retention and satisfaction, escalating issues whenever appropriate.
-- Achieves or exceeds assigned work standards.
-- Performs all duties in full compliance with all federal and state statutes, regulations and policies, CHAP requirements and policies and HCD's Compliance Program and Standards, including but not limited to, maintaining strict confidentiality and privacy of patients' protected health information (as defined by HIPAA) in accordance with HIPAA regulations, cooperating with internal and external investigations, reviews and audits, engaging in good faith reporting of compliance concerns, and participating in annual and ad hoc compliance training.
Home Care Delivered, Inc. - 2 years ago