Vacancy caducado!
Process in coming referrals from referring providers and maintain current status of members in the electronic medical records system. Disseminate status and missing documentation requirements through reporting mechanisms in place. Provide training and support to staff concerning correct claims input and progress notes, reporting systems and other related questions. Audit/review medical records database to ensure accuracy and identify areas for improvement.
Success in the role is measured on:
Ability to update and keep accurate records
Adjust and modify protocols to meet a changing industry
Communicate to all staff on the accuracy of data and to outside providers and agencies
Key Duties & Responsibilities:
Accept and process referrals from providers for services and enter into the Electronic Medical Record (EMR) system. Review and verify data, such as age, name, address, diagnosis, and all information needed for billing and denote deficiencies.
Verify eligibility in the approved systems from AHCCCS, Managed Care Organizations (MCOs), Contractors and other funders; at the time of referral and on-going monthly.
Disseminate reports and correspondence to staff, referring Providers, MCOs, Contractors and other funders on the status of members and to request updated/required documentation for correct billing.
Train staff on correct claims procedures concerning overproduction, progress notes, etc.
Audit/review EMR daily and as necessary to identify time overlaps, overproduction, missing group modifiers, etc.
Compile monthly summaries into individual format for delivery. Review staff progress notes for medical necessity, grammatical errors, spelling, etc.
Understand Explanation of Benefits (EOBs), process all claims paid and unpaid for rebilling, using insurance rate standards. Adjust and modify claims and Encounters to reflect accuracy in billing to MCOs and other Contractors, Funders, etc.
Understand the requirements and documentation necessary for state certification/licensing of staff and facilities. Assist claims manager in updating and submitting said documentation to MCOs, State agencies, etc.
Vacancy caducado!