Document Review Specialist

• Develop and maintain working knowledge of current HME products and services offered by the company.
• Review and manage patient eligibility documents such as prescriptions, certificates of medical necessity, letters of medical necessity and prior authorizations.
• Analyze documentation required for billing services and ensure compliance to payer requirements
• Review’s documentation to make sure it is valid prior to releasing to bill claims in order to ensure completeness and accuracy.
• Through daily work activities identifies trends, either system or process driven, that can be changed or modified to improve efficiency and create cost savings
• Accurately process, verify, and/or approve documentation to facilitate the release of claims to bill.
• Complete insurance verification to determine patient’s eligibility, coverage, co-insurances, and deductibles
• Must be able to navigate through multiple online EMR systems to obtain and or review applicable documentation
• Review and log all pertinent information in EMR system including initial authorizations, initial CMN and expiration dates
• Collaborates with AdaptHealth sales and support staff to ensure timely receipt of documentation.
• Communicate with leadership on an on-going basis regarding any noticed trends with insurance companies
• Verify insurance carriers are listed in the company’s database system, if not request the new carrier is entered
• Meet quality assurance requirements and other key performance metrics
• Maintain and review all required documentation for insurance coverage and reimbursement per insurance guidelines and company policy.
• Contact AdaptHealth operations teams, and centralized RCM teams, to obtain additional supporting medical necessity documents if warranted.
• Report to supervisor any apparent issues and coordinate submission of all required documentation.
• Assist with implementation of performance improvement program as it relates to billing and coding performance.
• Maintain patient confidentiality and function within the guidelines of HIPAA.
• Develop and maintain working knowledge of current HME products and services offered by the company.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliant with AdaptHealth’s Compliance Program.
• Perform other related duties as assigned.
• Maintain regular, predictable, consistent attendance and flexibility to meet the needs of the department.
• Understand and follow all Medicare, Medicaid, HIPAA, and Private Insurance regulations and requirements.
• Plan and organize work effectively and ensure its completion.

• Demonstrate team behavior and promote a team-oriented environment.
• Actively participate in continuous quality improvement.
• Always represent the organization professionally.

• One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.
• Senior level requires two (2) years of work-related experience and one (1) year of exact job experience.
• Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.

• Must be able to lift 30 pounds, stand, bend, stoop, and be able to sit at a computer for extended periods of time.
• Ability to perform repetitive movements of the upper extremity’s motions of wrists, hands, and/or fingers due to extensive computer use
• Work environment may be stressful at times, as overall office activities and work levels fluctuate
• Subject to long periods of sitting and exposure to computer screen
• Excellent ability to communicate both verbally and in writing
• Ability to utilize a personal computer and other office equipment
• May be exposed to angry or irate customers or patients

Originally posted on Himalayas