sms-quality assurance rep - Lansing, United States - Sparrow Health System

Description

Job Opportunity

Job ID:44177

Positions Location: Lansing, MI Job Description General Purpose of Job: Under

Description:

Positions Location: Lansing, MI

Job Description

General Purpose of Job:

Under the general direction of the department manager, researches and processes delivery documentation for durable equipment and supplies. Utilizes TIMS billing system and DIVER software to work unbilled validation error reports to resolve issues affecting the authroziation process and claim release. Works as department team member, assuring paperwork flow and answering documentation related questions for SMS Caregivers.

Essential Duties:

This job description is intended to cover the minimum essential duties assigned on a regular basis. Associates may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.

• Picks up hardgood and rental delivery documentation from designated areas daily to ensure paperwork is processed in a timely manner.
• Reviews paperwork to ensure requirements, waivers, insurances, signatures, are obtained as required. Verifies missing documentation according to written procedures. Confirms item delivery, verifies that physician name, diagnosis code and procedure code are entered, makes changes in system to match manual changes made on documentation.
• Verifies Authorization Number loaded in billing system. Returns invoices with missing documentation to QA Manager or appropriate Associate and ensures correct information is obtained. If required, calls patient directly to obtain information.
• Ensures correct information (i.e. delivery dates, asset numbers, etc.) have been entered into TIMS system to assure accurate billing and tracking.
• Utilizes TIMS spool files to work open order edit list, CMN processing as necessary.
• Functions as liaison between departments to ensure required documentation is complete and accurate for internal use (tracking rental equipment, preventative maintenance on rental equipment and care plans) and external billing (i.e. private and governmental payor) standards.
• Uses DIVER software to work unbilled validation errors as appropriate, and an a timely basis.
• Prepares documentation for imaging by separating paperwork containing Certificates of Medical Necessity (CMNs). Delivers documentation to appropriate CMN Specialist or Imaging Clerk.
• Prepares periodic report for Department Manager indicating number and type of paperwork errors, corrections made, and/or issues requiring follow-up. Maintains samples of documentation errors for associate training purposes.
• Reviews all customer service documentation to ensure completeness and accuracy.
• As needed, obtains written and verbal pre-authorizations from third parties in conjunction with Provider Relations Represenative and maintains accurate contact logs.
• Maintains the Procedure Code File for new items with missing procedure codes and allowables.
• Uses database systems/files to obtain pro-active and retro-active secondary authorizations and documents appropriately.
• Creates and assigns new rental numbers as ncessary and in conjunction with the Warehouse Coordinator.
• Adheres to Corporate Compliance Policies, including but not limited to current Medicare regulations.

Job Requirements

General Requirements
None

Work Experience
Minimum ONE year Home Medical Equipment customer service experience. Experience in insurance verification or claims processing preferred.

Education
High School diploma or GED

Specialized Knowledge and Skills
Knowledge of ICD9 coding and HCPC coding Personal computer knowledge Excellent communication skills, both verbal and written. Ability to work well under pressure, managing multiple tasks and deadlines.

Sparrow Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.

Job Family

Service/Support/Skilled Maintenance

Requirements:

Shift
Days

Degree Type / Education Level
High School / GED

Status
Full-time

Facility
Sparrow Medical Supply

Experience Level
New Grad