Documentation Specialist

Basic Function:

Under the direction of the Financial Services Lead, this position is responsible for all documentation activities relating to timely transitions of care.

Requirements:

1. High school diploma or equivalent.
2. Minimum of one-year experience in DME or Medical Office Customer Service.
3. Proven performance record in customer service.
4. Strong knowledge of federal and state regulations
5. Demonstrates ability to work successfully with internal and external contacts
6. Strong collaborative and skills in facilitating teamwork
7. Ability to work independently
8. Demonstrate excellent oral and written communication, problem solving, investigational and analytical skills along with excellent listening and interpersonal skills
9. Ability to multi-task, prioritize and manage time effectively

ADA CHECKLIST FOR PHYSICAL ACTIVITIES and REQUIREMENTS, VISUAL ACUITY, AND WORKING CONDITIONS OF THE POSITION

The following is a list of abilities required for this position, unless reasonable accommodations can be made in accordance with the Americans With Disabilities Act (ADA).

• Physical Activity – Sedentary work, exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time at employee workstation. Occasionally move about the inside of the office to access office machinery, file cabinets, or attend meetings.
• Talking – Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers or customers accurately.
• Visual Acuity – The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures or viewing a computer terminal.
• Hearing – Perceiving the nature of sounds at normal speaking levels with or without correction. Ability to receive detailed information through oral communication, and to make the discriminations in sound.
• Conditions – The worker is not substantially exposed to adverse environmental conditions, tasks are completed in an office environment.
• Finger Dexterity – Typing or otherwise working, primarily with fingers rather than with the whole hand as in handling. Constantly operates a computer and other office productivity equipment, such as a desk telephone, cellphone, calculator, copy machine, and computer printer.

JOB POSITION DESCRIPTION

Principle Responsibilities:

• Gathers documentation needed to support medical necessity to submit Prior Authorization for Durable Medical Equipment.
• Submit and maintain prior authorizations
• Submit and maintain all certificate of medical necessity (CMN)
• Receives appropriate paperwork and prescriptions as required
• Request documentation pertaining to continued need for PAP and Oxygen patients
• Review and Complete Stop/Hold report for documentation related stops and holds
• Enters all patient notes into EMR and verifies all information is complete and accurate
• Knowledge of Medicare LCD’s and Qualifications for home medical equipment
• Maintain current knowledge of Medicare, Illinois Public Aid and insurance industry policies and guidelines
• Interacts in strict adherence to HIPPA compliance regulations and related company policies
• Upload required documents to the patient account
• Responds to customer requests courteously and with respect
• Approaches customers and inquiries in a manner which represents ownership
• Resolves customer complaints by investigating problems and making recommendations to executive leadership
• Refers troubleshooting calls to appropriate department
• Reports any patient or referral related problems to Lead immediately
• Build and maintain positive relationships with referral sources to include education on medical equipment qualification and policy changes
• Promote company program and services to assigned referral source.
• Meets monthly and quarterly productivity goals
• Adherence to the Prism’s Employee Handbook
• Adherence to Prism’s Policies and Procedures
• Supports the mission, vision and strategic plan of the organization.
• Contributes to team effort by accomplishing related results
• Communicate necessary information to the Managers and Co-workers
• Participate in on-call schedule rotation
• Attend in-service training when required
• Performs other duties as assigned