Documentation Specialist
hace 6 días
Syracuse
Job Description INTRODUCTION Company Overview: This position is available with Upstate HomeCare, a BioMatrix company. BioMatrix is a nationwide, independently-owned infusion pharmacy with decades of experience supporting patients on specialty medication. Our compassionate care team helps patients navigate the often-challenging healthcare environment. We treat our patients like family and get them started on therapy quickly. We work closely with them as well as their family and their healthcare providers throughout the patient journey, staying focused on optimal clinical outcomes. At BioMatrix the heart of our Inclusion, Diversity, Equity, & Access (IDEA) philosophy is the commitment to cultivate a welcoming space where everyone’s contributions are acknowledged and celebrated. Our goal is to draw in, develop, engage, and retain talented, high-performing individuals from diverse backgrounds and viewpoints. We believe that both respecting and embracing diversity enriches the experiences and successes of our patients, employees, and partners. Schedule: Monday Through Friday From 8:30am Eastern Standard Time To 5pm Eastern Standard Time Work schedule is subject to change based on business needs. Location: Upon successful completion of on-site training, it is anticipated that an incumbent in this role will work on-site at our location in Syracuse, NY. Work location is subject to change based on business needs. Job Description: Directly provides efficient retrieval and management of all documentation required to bill claims for services provided. Ensures all documentation is aligned with prevailing company, state and federal payer standards. Adheres to strict governance in all aspects of obtaining complete and accurate documentation requirements. QUALIFICATION REQUIREMENTS • High school diploma or GED required, • Minimum of two (2) years of customer service experience in healthcare industry required, • Demonstrates strong computer literacy and aptitude as evidenced by proficiency and/or training with applicable software systems, • Knowledge of NYS payers, • Good written and verbal communication, • Prioritization skills, • Alignment to given instructions, • Providing excellent customer service by:, • Being courteous and prompt in response to customer/staff inquiries, • Explaining documentation requirements to co-workers, physicians, physician’s office staff, discharge planners, and customer and/or caregiver, • Documenting customer account issues/concerns (when applicable) and forwarding to the appropriate manager, • Improves departmental/company productivity and efficiency by:, • Obtaining required qualifying documents to include:, • CMN’s: Sending to physicians on a regular basis as established by company policy, • Doctor’s Orders: Sending to physicians on a regular basis as established by company policy, • Insurance requests for additional medical documentation (i.e., sleep studies, requests for additional documentation), • Prescriptions, • Insurance Prior Authorizations, • Renewal CMNs, • Renewal Insurance Prior Authorizations, • Medicaid Written Prior Authorizations, • Maintaining open communication with Branch Managers and CSR’s, • Reviewing and keeping all corporate billing hold reports current, • Monitoring timely acquisition of required documentation, • Monitoring all documentation for accuracy, • Reviewing documentation for qualification based on Compliance Policy, • Receiving all documentation in the computer system for release of all pending claims, • Volunteering or initiating assistance in other activities (not listed in job description) when it is beneficial to the department/company, • Follows company policies and procedures by:, • Understanding and following the Company’s Confidentiality Policy, • Serving as company resource on documentation issues, • Understanding scope and range of services, • Understanding and following complaint procedures, • Monitoring that appropriate signatures & medical justification accompany service orders, • Following applicable Medicare, Medicaid regulations, • Following state and insurance carrier regulations, • Following regulations set forth in company contracts, • Following company policy on CMN/medical justification retrieval, • Shows teamwork, initiative and accountability by:, • Volunteering to assist co-workers, • Staying current with industry/coverage changes, • Reviewing all documentation literature regularly to maintain updated on medical policy, • Presenting solutions in conjunction with problems, • Exhibits exceptional work ethics by:, • Not being wasteful or abusing branch/region resources (vehicles, buildings, equipment, supplies, phones, utilities, time at work and time absent from work, etc.), • Presenting fair and honest reports of expenses (travel, gas, on call, etc.), • Following through timely with commitments, • Allowing others to speak without interruption, • Asking clarifying questions and showing consideration of others comments, • Using proper grammar, a respectful tone and language free of prejudice, harassment, profanity or ill will connotations, • Answering calls within three rings and properly introducing self in a pleasant and clear voice, • Returning phone messages promptly, responding calmly to angry or upset referrals/customers and avoiding personal calls (or minimizes) to allow customer access to business lines Communication Skills • Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings., • This position requires constant sitting with occasional walking, standing, kneeling or stooping., • This position requires the use of hands to finger, handle or feel objects and the ability to reach with hands and arms., • This position requires constant talking and hearing., • Specific vision abilities required by this job include close vision and the ability to adjust focus. 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. If needing a reasonable accommodation within the application process, please contact the BioMatrix People & Culture team at or 954.385.7322 x 1425. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. OTHER • Will participate in legal and ethical compliance training each year., • Will consistently behave in compliance with the BioMatrix, LLC’s legal and ethical policies and procedures., • Will abide by the policies of BioMatrix, LLC as set forth in the Compliance Manual., • Will not participate in any conduct considered to be unethical or illegal. EXPECTATION FOR ALL EMPLOYEES Supports the organization's mission, vision, and values by exhibiting the following behaviors: integrity, dedication, compassion, enrichment and enthusiasm, places patients first, is all-in with stacked-hands, and is focused on relentless consistency wins. GENERAL INFORMATION: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate. Incumbents within this position may be required to assist or find appropriate assistance to make accommodations for disabled individuals in order to ensure access to the organization's services (may include: visitors, patients, employees, or others). All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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