Billing/Collections Specialist II- Medicare Recert
Provide support to the KCI Recert team by accurately evaluating incoming delivery and/or subsequent cycle documentation as well as initial orders ready for review to determine proper claim submission for reimbursement or adjustments based on departmental business procedure and understood Medicare reimbursement criteria.
Duties and Responsibilities:
- Conducting a full review of every active account based on the appropriate time frame required
- Manage documents in MDC Recert and MDC BillPending workbaskets in a timely manner and update VAC Recert accordingly.
- Return orders to appropriate business department/CSR for corrections which cannot be resolved with information provided.
- Verify that VAC Recert Tracking program is properly updated with correct start bill and cycles dates as well as cycle and processing statues including Wound Tracking
- Perform quality assurance check of documentation that has been submitted based on department guidelines.
- Review all incoming claims-related paperwork for completeness; note acceptance or exceptions and follow up on missing information to ensure claims are processed in a timely manner
- Ensure all payer and internal requirements are met for each order and ensures proper documentation is kept.
- Determine what claims will be sent to Medicare and how based on the use of several analysis processes and programs provided for this review
- Verify that all necessary information loaded into Delair billing system is correct
- Verify that all charges in billing system are posted with correct dates of service, modifiers and adjustments.
- Apply proper status codes on corresponding charges lines for pending actions or document deficiencies for correct unbilled allocation or department process
- B code any documents audited and used for supporting billing of claim with appropriate cycle
- Maintain C&C database entries for actions required in a timely manner
- Document and notify appropriate personnel to assist with the recertification procedure.
- Maintain courteous and timely communication with all customers at all times.
- Participates in any and all reasonable work activities as may be deemed suitable and assigned by management.
- Trouble shoot and problem solve any issues that arise and apprise management of any issues
- Follow-up with all corrections required in an accurate and timely manner
- Adhere to departmental standards, expectations and Service Level Agreements
- Conforms to, supports and enforces all Company policies and procedures.
- Performs all other duties as assigned
Qualifications & Skills:
- High School Diploma or equivalent.
- Personal computer experience with a high-level Word and Excel competency, MS Office applications.
- Two years’ experience within healthcare, medical billing, customer service, or relevant field
Additional preferred qualifications:
- Demonstrated analytical, problem-solving and organizational skills
- Demonstrated ability to communicate effectively, both verbally and in writing.
- Demonstrated ability to work effectively in a team environment, as well as, independently
- Must be able to participate in all required training programs.
- Demonstrated ability to deal effectively with all employees and external business contacts while conveying a positive, service-oriented attitude.
- Demonstrated ability to maintain complete confidentiality and discretion in business relationships and exercise sound business judgment.
- Some College a plus
- Ability to type at least 40 WPM
Requires repetitive keyboarding over 95% of the timeThe information listed above is not a comprehensive list of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice. Any physical and mental requirements described in this job description are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EOE AA M/F/Vet/Disability: Acelity L.P. Inc. and its subsidiaries are an equal opportunity and affirmative action employer and give consideration for employment to qualified applicants without regard to race, ethnicity, color, religion, sex, sexual orientation, gender identity, pregnancy, national origin, age, disability, veteran status, or genetic information or any other legally protected characteristic. If you'd like more information about your EEO rights as an applicant under the law, please click here: http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf VEVRAA Federal Contractor