Clinical Customer Service Representative
Under the direction and general supervision of the Hearings Supervisor, obtain medical record documents as determined necessary by clinician in support of Medicare billing and appeals.
1. Read and reply to e-mail in a timely manner as needed.
2. Listen and respond to voicemail in timely manner as needed
3. Provide supervisor with work progress reports on a daily, weekly, monthly basis or as required
4. To investigate and analyze patient charts by reading documents, and the patients’ physicians and/or nurses’ progress notes, and negotiating computer based research.
5. Review wound tracking for complete documentation needed for reconsideration of denial and/or partial denial of payment. (i.e. Number and type of wounds)
6. Ask medically appropriate questions to clinical field personnel
7. Correspond via email and phone with KCI customers in a professional and concise manner.
8. Consistently meet and maintain production level as dictated by management
9. Answer all incoming inquires regarding denial cases as appropriate.
10. Understand their role and impact they have in the departmental team; including exhibiting positive attitudes, willingness to help wherever asked, staying focused and on task to the matter at hand, and being part of the success of your team
11. Performs other duties as assigned.
• High School Diploma or equivalent
• Effective Communication skills
• PC skills
• Working 10-key and/or keyboarding skills
• Ability to prioritize
• Attention to detail
• Ability to enter data accurately
• Demonstrate good interpersonal skills
• Ability to maintain complete confidentiality and discretion in business relationships
• Demonstrate willingness and ability to participate in, and complete, all required training programs
• Ability to work effectively and exercise sound judgment in a team environment, as well as independently
• Demonstrate flexibility in work shift to meet department needs
• Demonstrate ability to deal effectively with all employees and external business contacts while conveying a positive service-oriented attitude
• Perform duties in an accurate and complete manner evaluated and validated via quality assurance assessment
• Ability to work at computer and maintain constant keyboarding
• Ability to work in a team environment as well as independently
• Six months medical office experience
• Ability to speak English and Spanish
• Basic knowledge of wound etiology to ask medically appropriate questions to Home Health Agencies, Physician’s offices and Wound Care Clinics
• Microsoft Word – basic knowledge
• Microsoft Excel – basic knowledge
• Microsoft Outlook – basic knowledge
• File Management – fundamental (External hires to be trained)
• MicroMD, Medical Manager, Delair – fundamental (External hires to be trained)
• Alchemy – fundamental (External hires to be trained)
• Hero – fundamental (External hires to be trained)
• VAC Recertification Program – fundamental (External hires to be trained)
• FileNet – fundamental (External hires to be trained)
This position reports to Hearings Supervisor
This position supervises/manages no one
Working conditions are typical of a general office environment. May require long periods of sitting or standing. Overtime may be required as deemed necessary by business objectives.The 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