Claims and Patient Care Manager Regenesis Biomedical
THIS JOB HAS EXPIRED Description
This position will support the national sales force as the primary lead in identifying and expanding the Company's Workman's Compensation provider and payer network. Responsible for receipt, and accurate processing of all required data and paperwork inlcuding referrals, clinician validation, initial and renewal prior authorizations, appeals, claim submission, payment reconiciliation and resolution of all issues related to non-FSS contract patients. Validates that care provided corresponds to submissions and that insurance covers treatment. Interfaces with physician offices, payers, insurance carriers. Manages patient contact and all related issues through a team of patient care coordinators. Identifies and implements improvements; ensures effective and efficient protocols. Duties also include:
Develop and implement systems for reporting / communicating.
Compile and analyze data regarding revenue / reimbursement issues and other metrics; prepare reports and graphics for presentations for control / reporting / management review.
Communicate with clinicians and others in the reimbursement cycle; facilitate and improve their understanding of our unique status and requirements.
Supervise activities of Patient Care Coordinator (PCC) team and support functions to provide exceptional customer service to internal and external customers.
Assure delivery of in-service training to all new patients via PCCs.
Assure PCCs contact all patients weekly and every following 30 days of treatment for Customer Satisfaction Surveys.
Assure smooth transfer of critical information between Sales Managers and patient.
Assure accurate data entry, ERP data capture & cleansing, filing and faxing.
Coordinate meetings to review claim rejections and develop appropriate response strategies.
Respond to requests for copies of patient medical charts and/or changes in codes/fees.
Assist in identifying fraudulent non-plan billing practices and support litigation efforts.
Perform special projects/tasks/reviews as assigned.
Workers Compensation experience highly desired (inlcudes patient / claims management as well as carrier interface)
4+ years experience in reimbursement/claims or related area, or equivalent combination of education/experience.
Associate?s Degree in Health Care Reimbursement or Certified Medical Reimbursement Specialist (CMRS) preferred
3+ years of supervisory experience preferred.
Solid working knowledge of medical terminology and proficiency with ICD, CPT and other coding.
Familiar with a variety of third party insurance regulations and billing practices.
Familiar with Reimbursement, Accounts Receivable and Billing operations.
Project Management experience and analytical abilities required.
Proficient in reading medical records and billing from the same.
Proficiency in Microsoft Word, Excel, Power Point and reimbursement related software.
Familiar with Crystal Reports.
Familiar with Medicare regulations and billing practices.
FDA / ISO experience helpful
||1435 North Hayden Road |
Scottsdale, AZ 85257
THIS JOB HAS EXPIRED