Documentation Representative

Attindas - US

3d

About The Position

The Documentation Representative is responsible for ensuring the timely renewal and acquisition of customer prescriptions, Prior Authorizations, Certificates/Letters of Medical Necessity, and other required documentation to comply with Medicare, Medicaid, and other Third Party payer regulations. This role involves extensive communication with physicians, customers, and payers through various channels to facilitate the receipt and validation of necessary documents. The representative must maintain accuracy in data entry, communicate effectively, and provide detailed information regarding processes. The position also requires the ability to handle challenging customer interactions, work cooperatively with colleagues, and contribute to department objectives while maintaining confidentiality.

Requirements

• Ability to communicate customer needs to physician office
• Ability to independently handle complaints and upset individuals during phone interactions
• Attention to details and accuracy along with strong organization
• Strong verbal, writing and typing skills
• Ability to multitask
• Cooperative and willing to assist others
• Able to use computer applications, telephone, PC, copier, fax machine and other basic business machines

Nice To Haves

• Ability to understand the billing/documentation requirements for governmental/Third Party payers strongly preferred
• Medicaid, Medicare and/or insurance customer service experience preferred

Responsibilities

• Promote and adhere to HDIS' Core Values: Integrity, Compassion, Excellence, Respect, and Commitment to Quality
• Take all actions necessary to ensure timely renewal/acquisition of customer prescriptions, Prior Authorizations, Certificates/Letters of Medical Necessity or other items required to be compliant with documentation regulations for Medicare, Medicaid and other Third Party payers
• Follow-up with physicians, customers and payers via inbound/outbound calls, emails, faxes or other means to facilitate receipt of prescriptions, certificates of medical necessity and other items necessary for service
• Communicate with customers, physicians, payers and others, both verbally and in writing, in a friendly, concise, professional manner
• Fax prescriptions to physicians, customers and payers as necessary
• Submit requests for PAs online, via fax, mail and other means as applicable
• Review incoming prescriptions, LMNs, CMNs and other documentation received via mail, fax or email and validate the accuracy of the documents per payer guidelines
• Enter documentation details quickly and accurately in HALO as applicable
• Verify that all information is current and complete at each interaction
• Accurately and completely communicate to leads, customers, physicians, payers and others, all items needed to initiate and/or continue services
• Determine customer needs or purpose of their call and provide detailed information regarding the Non-Private Pay process
• Run orders and update customer accounts accurately as applicable
• Research information beyond existing procedures as required to meet customer needs
• Potentially provide service to hostile or angry individuals/physicians
• Provide the needed assistance to the department regarding the documentation required by specified payer
• Work cooperatively with staff from own department and other departments to identify service problems, make recommendations, and plan and coordinate program and communication changes
• Work to meet or exceed individual goals and department objectives
• Maintain a high degree of confidentiality pertaining to customer situations
• Fill in as needed in other capacities of the company as required or assigned
• Complete special projects and miscellaneous assignments as required
• Assist the Verification Representatives as applicable as well all departments’ personnel as needed
• Keep management informed of area activities and of any significant problems
• Attend and participate in meetings as required
• Ensure that work area is clean, secure and well maintained

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed