Description

Reports to: Supervisor of Accounts Receivable

Job Location: REMOTE ~ King of Prussia, PA; New Providence, NJ; Concord, NC; Hollywood, FL

Summary of Key Job Function:

The position will entail the oversight of billing and collections of third party payor accounts for assigned payers. Ensure timely and accurate submission of claims and collections for the assigned payers. Ensure proper follow-up is performed on all aspects of the revenue cycle related to reimbursement, including projects, problem and issues escalation, denials management and research. Understand and communicate changes in payer guidelines and policies and be able to evaluate the effect of such changes. Follow internal and external policies and procedures. Escalate problems as necessary to ensure timely resolution. Ensure proper revenue is booked by monitoring payments, fee schedule changes, policy changes and other aspects that affect revenue, cash collections and adjustments. Be an expert in the knowledge of assigned payor policies, reimbursement and requirements.

Company Background/ Culture

PromptCare is a leading regional provider of home-based, specialty respiratory products and infusion therapy services. Headquartered in New Providence, New Jersey, PromptCare serves at-home pediatric and adult patients in New Jersey, New York, Connecticut, Massachusetts, Pennsylvania, Vermont, Rhode Island, Ohio, Delaware, Maryland and Kentucky on behalf of a large and diverse regional referral network of managed care organizations, hospitals, doctors and specialized care providers. Founded in 1985, PromptCare was initially a traditional, geriatric-focused home respiratory, infusion, and HME provider. In 2007, a new management team undertook several key initiatives including: an expansion of its geographic footprint into New England and the successful launch of its highly specialized pediatric ventilator program.

The following presents PromptCare’s two Respiratory business segments:

Respiratory (Adult Respiratory/ Pediatric Respiratory)

PromptCare is focused primarily on providing highly specialized products in the home to adult and medically fragile pediatric patients. PromptCare is increasingly recognized by referral sources and payers as one of the top Respiratory providers in its markets. After three years of careful positioning, PromptCare’s Pediatric Respiratory segment is rapidly becoming a highly recognized and sought after provider for fragile hi-tech pediatric ventilator patients in the Company’s service areas. The typical infant or pediatric patient suffers from a number of conditions and usually requires multiple modalities, including ventilators, oxygen, enteral, apnea monitors, pulse oximeters, cough assistance, and CPAP and BiPAP devices. The Company services this population from 20 primary locations.

The Company’s Adult Respiratory business provides products and services to home-based adults with serious and complex medical conditions such as COPD (Chronic Obstructive Pulmonary Disease), severe asthma, lung disease or severe spinal cord injuries.

Requirements

· Previous experience in DME is preferred

· Medical Reimbursement knowledge is preferred

· Brightree knowledge preferred

· Excel knowledge preferred

· Strong work ethic / Highly reliable

· Motivated and organized

· Independent thinker

· Ability to provide clear written and oral communication both internally and externally

· Deadline driven

· Thrives is a fast-paced environment

· Enjoys working closely with other departments and internal management to support overall goals

Job Qualifications:

· Bachelor’s degree preferred or comparable equivalent or related experience

· Excellent oral and written communication skills are required to communicate with patients, colleagues management, and insurance plan representatives

· Appropriate computer skills for the position (Microsoft Office Suite) and areas of influence, Brightree experience is preferred

· Strong work ethic with attention to detail and quality, is required

· Ability to identify and address issues independently

Job Duties and Responsibilities (Included but not limited to):

· Incorporate all Departmental and Administrative Policies and Procedures into daily activities.

· Maintain confidentiality in all aspects of patient care, employee activities and office environment.

· Organize work process in an efficient manner and prioritize tasks accurately on a daily basis.

· Incorporate company or departmental changes effectively.

· Foster positive work environment

· Ensure departmental goals are met by ensuring assigned work is done efficiently and timely

· Participate in projects or process updates as they relate to improving key outcomes

· Identify deficiencies and work to improve them through collaboration within the team and with other departments

· Work independently utilizing the tools and reports provided, ensuring compliance with internal and external policies

· Identify adjustments, payment trends and denials and ensure problems are escalated as necessary

· Suggest and collaborate on changes in policy, fee schedules and other limitations according to existing payer guidelines and update them as needed.

· Maintain and update shared documentation to assist Customer Service with the various policies, rules and limitations for insurance plans. Communicate changes regularly or as often as needed.

· Work collaboratively with other department staff such as CMN Specialist and Reauthorization Specialist to ensure timely collections

· Perform Brightree related transactions accurately and timely

· Contact patients as needed regarding account issues

Other Duties As Assigned:

· Perform other duties as assigned.

· Attend staff meetings, teleconferences and patient care conferences as needed.

· Able to lift a minimum weight of 35 pounds, and able to perform repetitive standing, sitting, stooping, walking, stretching, reaching, and use full range of body motions.

· Understand and follow PromptCare’s employee policies and procedures.