To inspire health and healing by putting patients first - ALWAYS.
•Position Summary The Claims Processor is responsible for the timely filing of all insurance claims, including electronic claims filing, secondary filing and paper filing.
•Minimum Qualifications Education High school diploma or equivalent is required.
•Physical Demands 1.Sit constantly.
3.Lift floor to waist height 30 pounds occasionally; waist to waist 25 pounds occasionally; waist to overhead 20 pounds occasionally. And carry 10 pounds up to 25 feet occasionally.
4.Reach overhead frequently standing and turn reaching shoulder height while sitting frequently.
5.Fine motor coordination within normal limits for age and gender.
6.Constant computer use.
7.Visual acuity within normal limits.
1.PROCESS CHARGES FOR VISITS, SUPPLIES,AND OTHER ITEMS - Accurately enters patient billing data, including visit charges and supply charges, into the information system.
2.REGULATIONS & GUIDELINES - Demonstrates knowledge and understanding of Home Health/Hospice revenue cycle components including regulations and billing guidelines.
3.HOSPICE PHARMACY CHARGES Reconciliation and transcription of Hospice Pharmacy charges, including scanning and tracking Proof of Delivery Forms. Collaborates with Great Plains Health Pharmacy to update/maintain Hospice medication chargemaster.
4.PRIOR AUTHORIZATION – Obtains all ongoing authorizations per payer requirements for all Home Health or Hospice services.
5.CODING - Ensures appropriate ICD-10 coding and sequencing as it relates to the patient’s medical condition, including any co-morbidities.
6.PRE-BILLING AUDITS - Performs non-clinical QA audit on each chart (visit verification, documentation requirements) especially as related to billing compliance.
7.CLAIMS SUBMISSION – Generation and transmission of electronic payer claims. Printing and mailing of paper claims where necessary.
8.NURSING HOME BILLING – collaborates with local nursing facilities on submission, collection, and payment of Medicaid room/board charges.
9.Demonstrates knowledge and understanding of Home Health/Hospice software application and office equipment and provides support for these as necessary.