Documentation Specialist

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Our benefits include: competitive compensation based on industry standards, an excellent benefits package, which includes: generous 401(k) match with immediate vesting, growth opportunities, health insurance benefit opportunities which include Medical, Dental, Vision, excellent PTO which increases based on tenure, holiday pay, and a fantastic company culture!

SUMMARY:

The Documentation Specialist is responsible for all aspects of obtaining & securing documentation and authorizations from insurance for goods and services provided by the company. This includes requesting any additional medical documentation, insurance authorizations & appealing any denied authorization requests.

ESSENTIAL FUNCTIONS:

1. Timely and accurate requests of prescriptions, certificates of medical necessity, any additional documentation, along with any corrections, authorization requests including all follow ups.
2. Review authorization denials. Resubmit & file appeals or adjust accounts according to established policy and procedure.
3. Helps educate patients on their financial responsibility for billed items and any applicable rules and regulations.
4. Communicates professionally with physician offices and all other referrals to obtain medical documentation necessary to secure authorization for payment.
5. Identifying insurance medical documentation requirements, prior authorization updates, and escalate identified issues to manager.
6. Work cooperatively with other department employees as needed to secure payments, including customer service, branches, sales and others as needed.
7. Maintain compliance with all applicable rules and regulations.
8. Support department projects and initiatives to achieve production goals.
9. Other duties as assigned by the Manager.

REQUIRED EDUCATION AND/OR EXPERIENCE:

1. High School diploma or GED equivalent.

PREFERRED EDUCATION AND/OR EXPERIENCE:

1. Six months’ accounts receivable or documentation/prior authorization experience in a healthcare/insurance/medical environment.

ADDITIONAL QUALIFICATIONS:

None.

COMPETENCIES:

• Adaptability
• Customer Service / Client Focus
• Detail oriented
• Problem solving
• Teamwork

POSITION TYPE/EXPECTED HOURS OF WORK:

This is a full-time position, and hours of work and days are Monday through Friday, 8:00 a.m. to 5:00 p.m. to start, with the possibility of flex scheduling based on department needs and individual performance.

SUPERVISORY RESPONSIBILITY:

This position has no supervisory responsibilities.

WORK ENVIRONMENT:

This job operates in a home or professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. This is primarily a sedentary position, spending most of the workday sitting at a desk in an office setting. The employee may occasionally be required to climb or balance; stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include both close and distance vision, color and peripheral vision, depth perception and ability to adjust focus.

TRAVEL:

No travel is typically not expected for this position.

OTHER DUTIES:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

EEO

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