Eligibility Coordinator (Full Time)
Company: Alive Hospice, Inc.
Location: Nashville
Posted on: February 25, 2021
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Job Description:
Eligibility Coordinator
Location:Nashville, TN
Status:Regular Full Time
Days:Monday - Friday
Hours: 40/week
Are you a Revenue Cycle/Insurance Eligibility professional who
desires to work in a capacity in which your efforts directly impact
clinicians, patients and their families? If you are excited to use
your talents and skill set in a way that truly makes a difference
in the middle Tennessee healthcare market, we can't wait to talk
with you!
SUMMARY
The Eligibility Coordinator, under the direction of the Director of
Revenue Cycle, is responsible for all duties related to payor
source verification and authorization and related to individual
letters of agreement.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Verifies insurance coverage/benefits for all hospice & palliative
care referrals. Work with Insurance Case Managers to maximize
services for patient and appropriate reimbursement for agency.
Enter all insurance information into EMR in proper filing order.
Completing pertinent insurance verification and notes. Include
patient liability and insurance specific services as applicable for
nursing home and physician services.
Obtains the initial authorization for services as well as ongoing
authorizations utilizing clinical documentation to support services
rendered. Enters obtained authorization information in EMR.
Monitors and maintains in EMR, authorization letters from payers to
ensure accuracy based on the services rendered.
Review and update EMR daily from status change emails, admission
and discharge reports for changes that affect billing compliance.
Obtain updated insurance authorization as applicable.
Review Medicare admissions for compliance and prepare NOE
spreadsheet for entry. Assist in NOE entry when needed. Maintain
NOE entry within 5-day for compliance with Medicare regulation and
report any non compliantaccounts to department director and billing
staff.
Exercises knowledge of Hospice regulations, and standards relative
to, TennCare/MCOs, Medicare and various other Payers.
Run IPU NP visit report and review visit note for MD
addendum/attestation and enter MD charge as appropriate. Complete
process throughout the month to not delay month end billing.
Assist in monthly compliance audits as requested by director. (MSPQ
& Live Discharge report)
Assists with collection efforts as it relates to authorized
services, dates, and individual hospice & palliative care benefits.
Works cooperatively with clinical and financial staff to achieve
goals.
Trouble shoots with internal clinical staff to research specific
patient insurance issues.
Other duties may also be assigned.
QUALIFICATIONS
To perform this job successfully, an individual must be able to
perform each essential duty satisfactorily. The requirements listed
below are representative of the knowledge, skill, and/or ability
required. Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential
functions.
EDUCATION and/or EXPERIENCE
Associate's degree (A.A.) or equivalent from two-year college or
technical school; minimum three years related experience and/or
training; or equivalent combination of education and experience.
Proficient Microsoft Office.
CERTIFICATES, LICENSES, REGISTRATIONS
If required to drive to carry out the duties of this position:
current driver's license and automobile insurance as required by
Tennessee state law.
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. Reasonable accommodations may be
made to enable individuals with disabilities to perform the
essential functions.
While performing the duties of this job, the employee is regularly
required to sit and talk or hear. The employee frequently is
required to use hands to finger, handle, or feel. The employee is
occasionally required to stand, walk, and reach with hands and
arms. The employee must occasionally lift and/or move up to 10
pounds. Specific vision abilities required by this job include
close vision, and color vision.
WORK ENVIRONMENT
The work environment characteristics described here are
representative of those an employee encounters while performing the
essential functions of this job. Reasonable accommodations may be
made to enable individuals with disabilities to perform the
essential functions.
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Keywords: Alive Hospice, Inc., Nashville , Eligibility Coordinator (Full Time), Other , Nashville, Tennessee
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