Scope & Purpose
This position is responsible for pre- and post-payment auditing of medical records and associated clinical documentation to ensure proper charge capture, billing in accordance with standard billing policies and reimbursement principles. This position is responsible for assisting Revenue Cycle Services, with resolution of charging, billing issues, and/or denials requiring clinical expertise, and participating in external audit requests, and special projects as needed. Travel to client’s location required in the beginning; may work remotely after initial training and quality assurance measures are consistently being met.
The essential functions of this position include but are not necessarily limited to the following:
- Responsible for managing external audit requests as approved by the President and/or Director of Operations.
- Retrieves and compiles data across multiple information systems and provides needed information for internal and external customers in a timely manner.
- Conducts defense audits requested by payers or outside agencies.
- Conducts cost outlier and high balance accounts audits or post third party vendor reviews.
- Prepares written reports or trending data related to findings and facilitates sign off with leadership.
- Facilitates timely turnaround of audit results.
- Prepares written summaries of audit results, which allow leadership the ability to monitor and manage their revenue capture and documentation processes.
- Keeps Director of Operations informed on various findings and communications with areas assigned for audit and/or process review.
- Other audits as assigned by the Director of Operations or President.
- Observes legal and ethical guidelines of HIPPA for safeguarding patient and company confidential and proprietary information.
- Consistently provides exceptional customer service for, and effectively communicates with, clients, patients, and payers.
- Exhibits a positive, courteous, respectful and helpful attitude to clients, co-workers, and management team.
- Understands and achieves team and individual goals as determined by supervisors.
- Promotes company culture by willingly adhering to all policies and procedures.
- Welcomes constructive feedback and makes every effort to improve when required to help meet company goals.
- Adapts to and demonstrates the ability to accept frequent changes in the work environment based on customers’ requirements.
Knowledge, Skills and Abilities
To perform this job successfully, it is recommended that the candidate or incumbent possess:
- Excellent technical skills and knowledge of medical systems used by clients.
- Ability to analyze statistical information and develop conclusions based on results.
- Demonstrated ability to apply excellent verbal and written communication skills.
- Demonstrated ability to apply exceptional customer service skills both internally and externally.
- Applied knowledge of problem-solving skills and the ability to find and implement solutions to correct a situation.
- Demonstrated ability to prioritize, multitask, organize and utilize time efficiently.
- Ability to learn about and promote the services offered by our company.
- Demonstrates initiative to learn and apply newly acquired skills.
- Ability to perform duties with minimal supervision and remain on task until completion.
- Ability and desire to work as a contributing team member.
- High School Diploma or GED required.
- Five years’ experience in infusion, DME and/or specialty pharmacy medical billing.
- Strong background and knowledge in medical billing policies and reimbursement principles, preferably in the Home Care Industry.
- A working background in multiple medical information systems.
- Thorough understanding of Revenue Cycle processes.
- Applicants must pass background, credit and drug screens.
- Infusion and/or specialty pharmacy: 5 years
- Revenue cycle processes in home care: 5 years
- Reimbursement principles and medical billing: 5 years