Documentation Specialist

About the Role

Ensures quality assurance for processed orders respecting Hart policies and insurance guidelines. Ensures the Certificate of Medical Necessity is completed to release claims. Documentation Specialists will specialize in either the Front End or Back End but will be cross-trained for both areas.

Key Responsibilities

• Front End

• Reviews documentation to confirm qualifications for insurance guidelines have been met.

• Creates Certificate of Medical Necessity within the system to encompass all billable items and qualifying diagnoses.

• Assists with unbilled report for applicable CMN holds – CMN Not Attached.

• Responsible for logging good/completed scripts for release of revenue.

• Back End

• Reviews new and old accounts needing a Certificate of Medical Necessity (CMN), checking for accuracy and completeness.

• Update any patient information or diagnosis information as needed.

• Assists with unbilled report for applicable CMN holds – renewal of expired CMN’s.

• Responsible for logging good/completed scripts or returned CMN’s.

• Make phone calls regarding unreturned CMN’s, meeting department phone call requirements, and trouble-shoot reasons CMN’s are not returned.

• Answer incoming calls from patients and physicians.

• Perform appropriate communication to ensure the doctor table within HDMS is maintain, updated and accurate.

• Obtain completed ABN when necessary for non-compliant patients.

• Work daily problem CMN’s that come back incomplete.

• Both

• Understanding and striving to meet or exceed department metrics, as well as continually tracking and taking ownership of all numbers that fall within the providership table.

• Maintain current knowledge on Medicare, Medicaid, and all third-party payers for equipment coverage and continued compliance.

• Uphold positive attitude towards tasks and co-workers, as well as a commitment to teamwork throughout the documentation team and the organization.

• Implement changes as requested that affect A/R and audit compliance.

• Other duties as requested by Management.

Requirements & Tech Stack

• Professional, proactive and positive demeanor with internal and external customers and coworkers.

• High school diploma or general education degree (GED).

• Minimum of six (6) months in a medical related field and/or training; or equivalent combination of education and experience.

• Excellent interpersonal, written and verbal communication skills.

• Attention to detail.

• Good data entry skills.

• Proficiency with computers, with strong typing skills.

• Good organization skills.

• English (verbal, written).

• Ability to add, subtract, multiply, and divide in all units of measure using a calculator.

• 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.

• No specific certifications, licenses, or registrations are required.

• Physical demands include sitting, talking, hearing; occasionally standing and walking; occasionally lifting/moving up to 25 pounds. Specific vision abilities required include close vision.

• Work environment is an office with moderate noise level.

• Training: Orientation and selected courses must be completed.