Duties:

1. Review and understand Insurance policies and standard Explanation of Benefits.
2. Review and understand medical documentation effectively.
3. Review and resolve request for medical records, related to
   • Claims processing
   • Internal and external audits
   • Authorized external entities
4. Monitors & maintains audit logs.
5. Performs internal audits for quality assurance.
6. Responsible for managing medical records of patients for insurance, private individuals and/or Government entities for home medical equipment.
7. Establishes and maintains effective communication and good working relationships with patients/family, physicians’ offices, and other internal teams for the patient’s benefit.
8. Performs other clerical tasks as needed, such as
   • Answering patient/Insurance calls
   • Faxing and Emails
9. Communicates appropriately and clearly to Manager/Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor
10. Other responsibilities and projects as assigned.

Requirements:

• High School Diploma or equivalent
• Knowledge of Explanation of Benefits from insurance companies
• Working knowledge of government, regulatory billing and compliance regulations/policies for Medicare & Medicaid
• Working knowledge of CPT and ICD-10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits.
• Knowledge of policies and procedures to accurately answer questions from internal and external customers.
• Utilizes initiative while maintaining set levels of productivity with consistent accuracy.

Experience:

• Minimum of 2 Years in DME experience required
• 3-5 Years in DME or medical billing experience preferred

Skills:

• Superior organizational skills.
• Proficient in Microsoft Office, including Outlook, Word, and Excel.
• Attention to detail and accuracy.
• Effective/professional communication skills (written and oral)

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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