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This position is responsible for requesting/managing supporting documentation and information required for claims submission and reimbursement for Medicare and other federal insurance. This role regularly interacts with patients, prescribers and their healthcare teams and will be required to build and maintain a professional relationship with these key customers. The Documentation Specialist plays a vital role in ensuring all payer rules and requirements are met and uphold Hillrom Respiratory Health high standard for Compliance.
Job Responsibility:
Documentation of Medical Necessity and Analyze documentation received to ensure medical requests are fulfilled
Manage retrieval of medically necessary documentation including updated prescriptions, statements of medical necessity, medical records information, and other diagnostic reports from healthcare customers
Resolve issues with any outstanding documentation requests defined as overdue. Solicit assistance of relevant stakeholders to initiate action plans necessary for retrieval
Review pertinent reports available to assist with management of administrative items and utilize for prioritization of workload
Educate healthcare accounts about documentation requests and the corresponding processes and regulations required by Medicare and other payers
Assist with new employees and provide refresher training as needed and communicate regularly with assigned field team regarding customer concerns or other escalated issues
Maintain and sustain department service level agreements as well as ensuring compliance with all payer rules and requirements
Verify eligibility and benefits of plan coverage and process for payer, as necessary and discuss Medicare or other relevant payer policies and limitations with Health Care Team
Requirements:
High School diploma, required associates degree or higher degree, preferred
Experience working in an office environment, preferred
Knowledge of medical terminology, helpful, Medicare experience strongly preferred
1+ years industry experience (3rd party payers or DME provider experience), preferred
Strong critical thinking and problem- solving skills
Exceptional written, verbal, and interpersonal communications
Proficient with Microsoft Office Software including Word and Outlook
What we offer:
medical and dental coverage that start on day one
insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP)
401(k) Retirement Savings Plan (RSP)
Flexible Spending Accounts
educational assistance programs
paid holidays
paid time off ranging from 20 to 35 days based on length of service