CASY-MSCCN Jobs

POSITION SUMMARY

To be fully engaged in providing Quality/No Harm, Customer Experience, and Stewardship by providing Uncompromised Safety, Superior Quality, Memorable Patient/Customer Experiences, and Financial Stewardship and ensuring the financial integrity of Health First, Inc. by performing established financial processes that enable and expedite the billing and collections. This includes Customer Service, billing claims according to Federal/State and Managed Care rules, regulations and compliance guidelines, patient account research and resolution, insurance verification and benefits determination, identification of reimbursement issues, resolution of credits and issuance of refunds, identification of payment variance invoices, follow up and resolution of denied claims.

*Primary Accountabilities *

1. Process medical equipment claims daily reviewing for batch failures, rejections, reviews reports for errors, adjust modifiers as needed, and troubleshoot claim information prior to transmitting.
2. Perform Quality Assurance chart reviews related to billing, customer service, signatures, orders, co-pay collections, reimbursement trends, timely filing, etc. to ensure federal guidelines, AHCA, and Joint Commission requirements are met.
3. Research patient accounts, resolving claim issues associated insurance and benefits verification. Identifying five year replacement of equipment and converting equipment to purchase.
4. Identify trends in failed claims, make corrections, and communicate to management. Use information from failed claims and chart reviews to assist in training associates on payer guidelines and requirements for dispensing medical equipment and billing.
5. Post payments, adjustments, and credits daily using general knowledge of third-party claims reimbursement practices. Process refunds for submission.
6. Understand, interpret, research, and appropriately handle basic insurance correspondences.
7. Analyze and resolve complex payer issues, payment trends and communicate to leadership promptly and accurately.
8. Apply Federal/State/Industry standard guidelines to resolve claim issues as approved by department leadership.
9. Identify process workflows, trends, and recommend improvements and share ideas that positively impact financial outcomes.
   10. Participate in month end and year end report processes. Communicate reports to Finance department.
   11. Attend meetings and webinars related to industry updates and report/train department staff on what is learned. Participate in projects analyzing department data to assist in education and process improvement.
   12. Work closely with Leadership and DME Buyer researching Lost, Stolen or Damaged items, reaching out to responsible parties to locate equipment.

*MINIMUM QUALIFICATIONS *

• Education: High School/GED.
• Licensure: None required.
• Certification: Successful completion of a Level II background screening.
• Work Experience: o One year experience in health care billing or related. o One year experience in a DME role.
• Work Experience in lieu of Education: None
• Knowledge/Skills/Abilities:
  o Knowledge of claims review and analysis. o Excellent verbal and written communication skills. o General knowledge of coding (ICD-9, ICD-10, CPT and HCPCS). o General knowledge of medical terminology. o Superior knowledge in all business office applications and systems including Microsoft Office. o Able to respond positively to stressful situations and changes. o Demonstrated effective communication and problem-solving skills. o Positively and professionally, interact with customers and associates. o Demonstrated ability to work effectively as a team member. o Self-directed and capable of working without direct supervision.

*PREFERRED QUALIFICATIONS *

• Education: Bachelor’s degree in related field.
• Licensure: No additional.
• Certification: No additional.
• Work Experience: 3 years progressive experience in health care billing.

• Knowledge/Skills/Abilities: No additional.

  *PHYSICAL REQUIREMENTS *

• Majority of time involves sitting or standing; occasional walking, bending, stooping.

• Long periods of computer time or at workstation.
• Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
• May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
• Communicating with others to exchange information.
• Visual acuity and hand-eye coordination to perform tasks.
• Workspace may vary from open to confined; on site or remote.
• May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.

Job: *Clerical Support

Organization: *HRE dba HF Medical Equipment

Title: DME Claims Specialist - Medical Equipment Administration

Location: Florida - Brevard County-Rockledge

Requisition ID: 074947