Reimbursement Specialist Home Health

Summary

POSITION INFORMATION

Position summary:

This position is responsible for handling tasks related to reimbursement and is expected to perform all areas of authorization, understanding and communicating billing requirements for each insurance, performing Sandata functions for patients utilizing Medicaid services and the auditing of medical records prior to billing. Demonstrates an ability to find solutions to problems and keeps management informed of patterns regarding authorization issues, compliance issues, payment and or other issues with specific payers. Works independently to obtain authorizations for all Home Health Services patients. Timely review of episodic and Medical billing periods to ensure all requirements are met prior to billing.

MINIMUM QUALIFICATION

Education:

• High school graduate or equivalent required. Knowledge of medical terms is required.

Required length and type of experience:

• Minimum one year of medical records, insurance authorization or auditing experience in a medical setting required. Prior experience in a health care office or home care agency preferred.

Required licensure, certification or registry:

• None

KEY RESPONSIBILITIES AND DUTIES

Below are the duties and responsibilities for this position:

• Perform complete billing audits based on Home Health regulatory guidelines to ensure accurate claim submissions.

• Reviews medical record upon patient admission to ensure data entry and documentation accuracy.

• Tracks authorization time frames and reports to clinical staff their deadlines ensuring authorization is obtained for each visit, reporting any discrepancies that may prohibit claim payment to direct supervisor.

• Update Sandata site for patients utilizing Medicaid services to ensure all visits are accurately reported.

• Completes data entry into electronic medical record and other systems, generating reports and proofreading for accuracy.

• Handles all customer service calls both internal and external in a professional and courteous manner.

• Entering or creating spreadsheets for additional projects and tracking purposes as needed.

• Performs other job-related duties within the job scope as requested by management.