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Medical Billing QA Processor
at James Scarpace in San Jose
Overview
Reporting to the Patient Accounts Supervisor and Lead, individual will be responsible for the assistance in the areas of check-in, registration of patients, scanning and invoicing of all Patient Care Records.
Responsibilities
Administration/Quality Assurance
• Receipt and processing of Patient Care Reports (PCR's)
• Review of PCR's to compile data
• Assist customer service in an efficient and helpful manner
• File or retrieve reports and records as needed
• Determines whether a Physician Certificate Statement (PCS) is needed and received, if applicable
• Track all aspects of missing PCRs, PCSs and determines appropriate processing
• Reconciliation of PCR and transport numbers on a daily and monthly basis
• Respond to requests for information
• Make decisions and take appropriate actions based on sound reasoning and judgment.
• Contribute ideas; strive to enhance team effectiveness and support decisions made by the team.
• Plan and perform work systematically and efficiently.
• Carry out instructions, maintain a positive attitude, and support company policies/procedures.
• Punctuality and availability for workload.
• Comply with HIPAA guidelines
• Attend and maintain all required R/M training
• Gather & scan supporting documents
• Obtain prior authorization process
• Review PCR’s for completeness & return to crew/ops for addendums as needed
• Contacts hospitals and requests updated face sheets for PCRs that lack complete patient information.
• Work with hospital liaisons and facility staff to obtain Physician Certification Statements (PCSs) for transports.
• Complete and submit Treatment Authorization Requests for medical patients obtaining all required documentation. Respond to requests for additional information, appeal denials. (This is applicable for California only)
• Sends invoices and follows up with contract payers for claims not covered under capitated contracts.
• All other duties as assigned
Customer Service
• The ability to provide service and quality communications exhibiting a professional attitude at all times.
Compliance
• Complies and enforces all policies and procedures.
• Ensures and inspects paperwork for accuracy and compliance.
• Responsible for escalating concerns regarding questionable paperwork to appropriate management.
• Has successfully completed all required Compliance Training within the required time period.
• Has had no compliance related corrective action during the current review period.
Qualifications
• High school diploma or GED required
• Ability to read, write and speak English in an easily understood manner.
• Ability to type 40-50 wpm
• Strong medical terminology background, CPT, ICDP coding
• Knowledge of HCFA 1500 forms and Medicare guidelines are essential for completion of the data entry process.
Reporting to the Patient Accounts Supervisor and Lead, individual will be responsible for the assistance in the areas of check-in, registration of patients, scanning and invoicing of all Patient Care Records.
Responsibilities
Administration/Quality Assurance
• Receipt and processing of Patient Care Reports (PCR's)
• Review of PCR's to compile data
• Assist customer service in an efficient and helpful manner
• File or retrieve reports and records as needed
• Determines whether a Physician Certificate Statement (PCS) is needed and received, if applicable
• Track all aspects of missing PCRs, PCSs and determines appropriate processing
• Reconciliation of PCR and transport numbers on a daily and monthly basis
• Respond to requests for information
• Make decisions and take appropriate actions based on sound reasoning and judgment.
• Contribute ideas; strive to enhance team effectiveness and support decisions made by the team.
• Plan and perform work systematically and efficiently.
• Carry out instructions, maintain a positive attitude, and support company policies/procedures.
• Punctuality and availability for workload.
• Comply with HIPAA guidelines
• Attend and maintain all required R/M training
• Gather & scan supporting documents
• Obtain prior authorization process
• Review PCR’s for completeness & return to crew/ops for addendums as needed
• Contacts hospitals and requests updated face sheets for PCRs that lack complete patient information.
• Work with hospital liaisons and facility staff to obtain Physician Certification Statements (PCSs) for transports.
• Complete and submit Treatment Authorization Requests for medical patients obtaining all required documentation. Respond to requests for additional information, appeal denials. (This is applicable for California only)
• Sends invoices and follows up with contract payers for claims not covered under capitated contracts.
• All other duties as assigned
Customer Service
• The ability to provide service and quality communications exhibiting a professional attitude at all times.
Compliance
• Complies and enforces all policies and procedures.
• Ensures and inspects paperwork for accuracy and compliance.
• Responsible for escalating concerns regarding questionable paperwork to appropriate management.
• Has successfully completed all required Compliance Training within the required time period.
• Has had no compliance related corrective action during the current review period.
Qualifications
• High school diploma or GED required
• Ability to read, write and speak English in an easily understood manner.
• Ability to type 40-50 wpm
• Strong medical terminology background, CPT, ICDP coding
• Knowledge of HCFA 1500 forms and Medicare guidelines are essential for completion of the data entry process.
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Published at 12-28-2011
Viewed: 53 times
Viewed: 53 times