Documentation Specialist

IRB Medical Equipment LLC • Grand Blanc, MI

1d • Onsite

About The Position

The Documentation Specialist ensures quality assurance for processed orders in accordance with Hart policies and insurance guidelines, and ensures Certificates of Medical Necessity (CMNs) are completed so claims can be released. Specialists focus on either Front End or Back End duties and receive cross-training in both areas.

Front End work includes reviewing documentation to confirm insurance qualifications, creating CMNs in the system to cover billable items and qualifying diagnoses, assisting with applicable CMN holds on unbilled reports, and logging completed scripts for revenue release. Back End work includes reviewing new and existing accounts for accurate and complete CMNs, updating patient or diagnosis information, handling applicable renewal holds, logging completed scripts or returned CMNs, contacting parties about unreturned CMNs, answering patient and physician calls, maintaining accurate physician records in HDMS, obtaining completed ABNs when needed for non-compliant patients, and resolving incomplete CMNs.

Across both areas, the specialist works to meet department metrics, tracks and takes ownership of figures in the providership table, maintains current knowledge of Medicare, Medicaid, and other payer coverage and compliance requirements, supports teamwork and positive working relationships, and implements requested changes affecting accounts receivable and audit compliance. Other duties may be assigned by management. The role is performed in an office environment with moderate noise. Orientation and selected courses must be completed within the designated time frame.

Requirements

• High school diploma or GED.
• At least six months of experience in a medical-related field and/or training, or an equivalent combination of education and experience.
• Professional, proactive, and positive approach with internal and external customers and coworkers.
• Excellent interpersonal, written, and verbal communication skills.
• Attention to detail.
• Good data entry skills.
• Computer proficiency and strong typing skills.
• Good organizational skills.
• English verbal and written proficiency.
• Ability to add, subtract, multiply, and divide using a calculator.
• Ability to understand and carry out written, oral, or diagram-form instructions using common sense, and to solve problems involving several concrete variables in standardized situations.

Responsibilities

• Review documentation to confirm insurance guideline qualifications have been met.
• Create Certificates of Medical Necessity in the system covering billable items and qualifying diagnoses.
• Assist with applicable CMN holds on unbilled reports, including CMNs not attached and expired CMN renewals.
• Log completed scripts for revenue release and log completed scripts or returned CMNs.
• Review new and existing accounts requiring CMNs for accuracy and completeness.
• Update patient and diagnosis information as needed.
• Make calls regarding unreturned CMNs, meet department call requirements, and troubleshoot reasons CMNs are not returned.
• Answer incoming calls from patients and physicians.
• Ensure physician information in the HDMS doctor table is maintained, updated, and accurate.
• Obtain completed ABNs when necessary for non-compliant patients.
• Work daily CMNs returned as incomplete.
• Work toward or exceed department metrics and track and take ownership of numbers in the providership table.
• Maintain current knowledge of Medicare, Medicaid, and third-party payer equipment coverage and compliance requirements.
• Maintain a positive attitude and commitment to teamwork with colleagues and customers.
• Implement requested changes affecting accounts receivable and audit compliance.
• Perform other duties as requested by management.
• Complete orientation and selected courses within the designated time frame.
• Work safely.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED