Responsible for coordinating with staff and insurance companies to verify insurance coverage, reimbursement, and benefits. In charge of obtaining insurance authorizations, tracking AR, billing, requesting authorizations, and monitoring. Responsible for maintain and updating agency credentialing & regulatory information with all payor sources & licensing/accrediting bodies. Responsible for the maintenance and organization of all regulatory documents for the agency as it relates to billing, follow-up, and payments.
Responsibilities:(40%)*Communicates with insurance companies to confirm insurance benefits for services, room and board, supplies and equipment and obtain authorization of coverage using multiple systems.
(20%)*Acts as liaison between manager, case managers/representatives, and agency staff to obtain initial and ongoing insurance coverage, charges, adjustments, and to meet patient needs.
(20%)*Maintains and updates credentialing & regulatory information for all agency service lines. Updates information as required to ensure that information is the most accurate and up-to-date.
(10%)*Serves as the advocate for Agency services when communicating with insurance company representatives, billers, and management.
(10%)*Maintains tracking system to coordinate update reports and requests of agency service coverage by insurance companies.
OTHER DUTIES AND RESPONSIBILITIES:
Knowledge of Agency policies and procedures.
Ability to communicate effectively, verbally and in writing.
Ability to speak, write, and understand the English language.
Ability to recognize needs and concerns of people and maintain constructive interpersonal relationships.
Ability to work independently, demonstrating problem solving and organizational skills.
Knowledge of home care services provided by nursing, rehab services, social work, and home health aides.
Ability to communicate effectively via telephone and establish telecommunication relationships.
Ability to access computer clinical software and patient record to obtain patient information.
MyMichigan Health is a technology driven organization and employees need to demonstrate competency in Microsoft Windows. An employee may be required to participate in further learning opportunities offered by MyMichigan Health
Other duties as assigned.
Certifications and Licensures:FINGERPRIN: Fingerprinting
Required Education:HIGH SCHOOL DIPLOMA
Other Information:EXPERIENCE, TRAINING AND SKILLS:
Working knowledge of Microsoft Outlook, Word, Excel and PowerPoint, and computer experience with spreadsheet and/or database required.
Three years experience in a medical billing office setting Knowledge of medical terminology, health system approved abbreviations and ICD-9 coding skills.
Knowledge of HME/Home Infusion procedure coding and insurance payer contractual differences.
Knowledge of agency policies and procedures.
Ability to speak, write, and understand the English language.
Ability to communicate effectively, verbally and in writing.
Ability to recognize needs and concerns of people and maintain constructive interpersonal relationships.
Ability to troubleshoot and resolve a variety of computer-related problems.
Ability to work under pressure of deadlines, changes in schedules and office routines.
Organizational skills require working independently, demonstrating problem solving skills and prioritizing a variety of responsibilities.
College or vocational education training preferred Education and/or experience in the home medical equipment industry preferred.
Medical terminology classes preferred Advanced knowledge of Automated Billing Software TIMS preferred
PHYSICAL/MENTAL REQUIREMENTS AND TYPICAL WORKING CONDITIONS:
Exposure to stressful situations, including those involving public contact, as well as, trauma, grief and death.
Able to wear personal protective equipment that includes latex materials or appropriate substitute if required for your position.
Is able to move freely about facility with or without an assisted device and must be able to perform the functions of the job as outlined in the job description.
Overall vision and hearing is necessary with or without assisted device(s).
Frequently required to sit/stand/walk for long periods of time. May require frequent postural changes such as stooping, kneeling or crouching.
Some exposure to blood borne pathogens and other potentially infectious material. Must follow MyMichigan Health bloodborne pathogen and TB testing as required.
Ability to handle multiple tasks, get along with others, work independently, regular and predictable attendance and ability to stay awake.
Overall dexterity is required including handling, reaching, grasping, fingering and feeling. May require repetition of these movements on a regular to frequent basis.
Physical Demand Level: Sedentary. Must be able to occasionally (0-33% of the workday) lift or carry 0-10 lbs.