Overview
Quality Auditor Jobs in Coldwater, OH at Jr Manufacturing Inc
Description:
Position Summary:
The Quality Assurance Specialist is responsible for reviewing delivery/shipping tickets and on-site orders to ensure AdaptHealth is meeting compliance standards according to accreditation and payer regulations/guidelines prior to confirming the delivery ticket in our billing system. Their review will include, but not limited to, things such as proof of delivery standards and accuracy of CMS or managed care payer billing guidelines. The Quality Assurance Specialist will be responsible for confirming all delivery/shipping tickets and on-site orders daily as received from the regions and indexing each ticket onto the appropriate EMR after confirmation.
Essential Functions and Job Responsibilities:
Develop and maintain working knowledge of current HME products and services offered by the company.
Accurately enters patient notes and updates into patient records
Reviews documentation to make sure it is valid prior to processing an order to ensure completeness and accuracy.
Verifies or obtains alternate contact information
Verifies delivery address, delivery instructions and telephone number for all orders
Understands and utilizes the most cost-effective delivery method for items ordered
Documents accounts with any delivery expectations and requests
Through daily work activities identifies trends, either system or process driven, that can be changed or modified to improve efficiency and create cost savings
Accurately process, verify, and/or submit documentation and orders
Complete insurance verification to determine patient’s eligibility, coverage, co-insurances, and deductibles
Must be able to navigate through multiple online EMR systems to obtain applicable documentation
Enter and review all pertinent information in EMR system including authorizations and expiration dates
Communicate with leadership on an on-going basis regarding any noticed trends with insurance companies
Verify insurance carriers are listed in the company’s database system, if not request the new carrier is entered
Meet quality assurance requirements and other key performance metrics
Maintain and review all required documentation for insurance coverage and reimbursement per insurance guidelines and company policy
Contact AdaptHealth sales and/or operations teams, and physicians, to obtain additional supporting medical necessity documents
Report to supervisor any apparent issues and coordinate submission of all required documentation.
Assist with implementation of performance improvement program as it relates to billing and coding performance.
Maintain patient confidentiality and function within the guidelines of HIPAA.
Develop and maintain working knowledge of current HME products and services offered by the company.
Completes assigned compliance training and other educational programs as required.
Maintains compliant with AdaptHealth’s Compliance Program.
Perform other related duties as assigned
Requirements:
Competency, Skills and Abilities:
• Knowledge of Medicare, Medicaid, and commercial health plan reimbursement methodologies and documentation requirements. • Excellent verbal and written communication skills.
Well organized, detail oriented and possess strong problem-solving and critical thinking skills.
Ability to prioritize tasks, manage multiple projects and work independently
Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.
Ability to read and interpret documents such as Medicare, Medicaid and commercial health plan policy articles and procedure manuals.
Ability to prepare routine reports and correspondence.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
Computer Skills: Strong proficiency in Microsoft Office: Excel, Word, Outlook
Education and Experience Requirements:
• High School Diploma or equivalent • One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.
Senior level requires two (2) years of work-related experience and one (1) year of exact job experience.
Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.
Physical Demands and Work Environment:
Must be able to lift 30 pounds, stand, bend, stoop, and be able to sit at a computer for extended periods of time.
Ability to perform repetitive movements of the upper extremity’s motions of wrists, hands, and/or fingers due to extensive computer use
Work environment may be stressful at times, as overall office activities and work levels fluctuate
Subject to long periods of sitting and exposure to computer screen
Excellent ability to communicate both verbally and in writing
Ability to utilize a personal computer and other office equipment
May be exposed to angry or irate customers or patients
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Title: Quality Auditor
Company: Jr Manufacturing Inc
Location: Coldwater, OH
