Position Summary:

The Billing Continuity Representative is responsible for the daily insurance verification, prior authorization, and correct posting of charges for respiratory home care, home medical equipment and supplies, and contract billing for his/her assigned caseload of patients. This employee monitors accurate charge postings via the Brightree software system Patient insurance benefits, include but are not limited to, Medicare, Medical Assistance, and numerous third-party payers to assure adequate and timely reimbursement. This job also monitors and works with patients in regard to compliance for insurance coverage.

Essential Job Knowledge:

• Obtains all renewal authorizations as well as initial authorizations that are needed after dispensing.
• Obtains all convert to purchase authorizations, follows up on all rentals compliance for convert to purchase, and renewal prescriptions.
• Communicates with patients via phone calls and letters explaining their state of compliance and their responsibility to become compliant.
• Answers questions regarding insurance coverage of services.
• Checking insurance eligibility and verifying qualifications needed for all insurance changes. 
• Monitors and forwards any documentation requested by payers for reimbursement purposes.
• Reviews monthly Brightree report which identifies patients that have insurance changes or will be eligible for Medicare benefits based on their age.
• Assures the federally required documents are obtained and maintained in a complete and timely manner. 
• Is familiar with legislation that impacts the delivery of and billing of services.
• Reviewing and completing all WIPS and Tasks as assigned to Billing Continuity team and individual members.
• Follows procedures to monitor Medicare and Medicaid rules and regulations to assure appropriate and optimum reimbursement.
• Attends workshops, meetings, and seminars to keep the department abreast of the changes in legislation, regulations, and industry practices.
• Provides peer review input on selected employee performance reviews.
• Successfully completes initial and ongoing organizational and department education, training, and competency requirements.
• Infection Control: Understands, demonstrates, and follows organizational infection control guidelines (CDIC).
• Quality: Focuses on improving processes and champions efficiency in daily work activities.
• Safety: Promotes a culture of safety by taking accountability for individual actions, including but not limited to, promptly reporting errors or near misses via the organization’s occurrence reporting system and participating in developing improved safety processes, as appropriate. (ADM015, ADM016, OPS044, Mission Statement).
• Performs other duties as assigned.