Documentation Specialist
Summary
A documentation specialist at Quipt Home Medical reviews insurance paperwork for durable medical equipment orders, creating and tracking Certificates of Medical Necessity (CMNs) in the HDMS system so claims can be billed. Work spans front-end claim release and back-end CMN follow-up, including calls to patients and physicians, using Medicare/Medicaid guidelines.
SUMMARY: Ensures quality assurance for processed orders respecting Hart policies and insurance guidelines. Ensures the Certificate of Medical Necessity is completed to release claims.
ESSENTIAL DUTIES AND RESPONSIBILITIES: Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.
Documentation Specialists will specialize in either the Front End or Back End. However, they will be cross trained for both areas.
Front End:
- Reviews documentation to confirm qualifications for insurance guidelines have been met.
- Creates Certificate of Medical Necessity within the system to encompass all billable items and qualifying diagnoses.
- Assists with unbilled report for applicable CMN holds – CMN Not Attached.
- Responsible for logging good/completed scripts for release of revenue.
Back End:
- Reviews new and old accounts needing a Certificate of Medical Necessity (CMN), checking for accuracy and completeness.
- Update any patient information or diagnosis information as needed.
- Assists with unbilled report for applicable CMN holds – renewal of expired CMN’s.
- Responsible for logging good/completed scripts or returned CMN’s.
- Make phone calls regarding unreturned CMN’s, meeting department phone call requirements, and trouble-shoot reasons CMN’s are not returned.
- Answer incoming calls from patients and physicians.
- Perform appropriate communication to ensure the doctor table within HDMS is maintain, updated and accurate.
- Obtain completed ABN when necessary for non-compliant patients.
- Work daily problem CMN’s that come back incomplete.
Both:
- Understanding and striving to meet or exceed department metrics, as well as continually tracking and taking ownership of all numbers that fall within the providership table.
- Maintain current knowledge on Medicare, Medicaid, and all third party payers for equipment coverage and continued compliance.
- Uphold positive attitude towards tasks and co-workers, as well as a commitment to teamwork throughout the documentation team and the organization.
- Implement changes as requested that affect A/R and audit compliance.
- Other duties as requested by Management.