Documentation Specialist

Description

SUMMARY: Ensures quality assurance for processed orders respecting Hart policies and insurance guidelines. Ensures the Certificate of Medical Necessity is completed to release claims. 

ESSENTIAL DUTIES AND RESPONSIBILITIES: Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

Documentation Specialists will specialize in either the Front End or Back End. However, they will be cross trained for both areas.

Front End:

• Reviews documentation to confirm qualifications for insurance guidelines have been met.
• Creates Certificate of Medical Necessity within the system to encompass all billable items and qualifying diagnoses.
• Assists with unbilled report for applicable CMN holds – CMN Not Attached.
• Responsible for logging good/completed scripts for release of revenue.

Back End:

• Reviews new and old accounts needing a Certificate of Medical Necessity (CMN), checking for accuracy and completeness.
• Update any patient information or diagnosis information as needed.
• Assists with unbilled report for applicable CMN holds – renewal of expired CMN’s.
• Responsible for logging good/completed scripts or returned CMN’s.
• Make phone calls regarding unreturned CMN’s, meeting department phone call requirements, and trouble-shoot reasons CMN’s are not returned.
• Answer incoming calls from patients and physicians.
• Perform appropriate communication to ensure the doctor table within HDMS is maintain, updated and accurate. 
• Obtain completed ABN when necessary for non-compliant patients.
• Work daily problem CMN’s that come back incomplete.

Both: 

• Understanding and striving to meet or exceed department metrics, as well as continually tracking and taking ownership of all numbers that fall within the providership table.
• Maintain current knowledge on Medicare, Medicaid, and all third party payers for equipment coverage and continued compliance.
• Uphold positive attitude towards tasks and co-workers, as well as a commitment to teamwork throughout the documentation team and the organization. 
• Implement changes as requested that affect A/R and audit compliance.
• Other duties as requested by Management.

Requirements

QUALIFICATIONS

To perform this job successfully, an individual must be professional, proactive and positive with internal and external customers and coworkers. The requirements listed below are representative of the knowledge, skill, and/or ability required. 

Education and/or Experience

• High school diploma or general education degree (GED).
• Minimum of six (6) months in a medical related field and/or training; or equivalent combination of education and experience. 

Skills & Abilities

• Excellent interpersonal, written and verbal communication skills. 
• Attention to detail
• Good data entry skills
• Proficiency with computers, with strong typing skills.
• Good organization skills

Language Skills

English (verbal, written)

Mathematical Skills

Ability to add, subtract, multiply, and divide in all units of measure using a calculator.

Analytical & Problem Solving Ability

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

CERTIFICATES, LICENSES, REGISTRATIONS

None

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit, talk and hear. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision. All employees are required to work in a safe manner.

WORK ENVIRONMENT

The work environment described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Office environment with moderate level noise.

TRAINING

Orientation and selected courses must be completed in the designated time frame.

ADDITIONAL QUALIFICATIONS

None

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Employee signature below constitutes employee’s understanding of the requirements, essential functions and duties of the position. This document is not to be construed as an employment contract of any kind.