Website UR Medicine Home Care

FUNCTION: Responsible to investigate, review, monitor, correct and track system related errors from various reports within McKesson such as CBEL, BBEL, and GenEnd. Works with PFS to provide timely resolution to billing inquiries. Includes CHHA, Hospice, and LHCSA Agencies.

REPORTS TO: Director of Performance Improvement and Clinical Education

RELATIONSHIPS: Clinical Management, Quality Department, Hospice, Education, Patient Financial Services, HIM, Agency Administration, LHCSA,

HOURS: 8:00 a.m. – 4:30 p.m., Monday thru Friday

SUPERVISES: N/A

RESPONSIBILITIES:

  1. Responsible for the review and correction of all clinically related service batch verification error messages on the Clinical Batch Error Log (CBEL).
  2. Responsible to support PFS on clinical issues related to the Billing Batch Error Log (BBEL) issues.
  3. Supports PFS in review and clinical correction of the Verification/Adjustment (GenEnd) reports as necessary.
  4. Reviews all documentation requests by third party payers to respond to claim denials for medical justification including but not limited to Medicare ADR’s and Medicaid Determinations.
  5. Monitor and track on weekly basis system errors that incorporate measurable outcomes showing a reduction in system errors. Report these outcomes to Supervisor and Administration via dashboard reports.
  6. Responsible for, performs and oversees Agency Rebuild process.
  7. Responds to and resolves billing inquiries regarding the agency based issues for clinical documentation support for the billable service.
  8. Documentation specialist in all areas of Certified Agency Clinical Documentation/Justification Requirements including but not limited to 5 elements of Medicare documentation. Reviews charts as needed.
  9. Supports Quality Management and Hospice Quality Management as needed.
  10. Assist Agency with staff training and education on areas in relation to system errors for CBEL/ BBEL, rebuild prevention, Medical Documentation.
  11. Responsible for the Key Performance Indicators (KPI’s) established by their manager.

QUALIFICATIONS:

  1. Registered Nurse, Bachelor’s degree required.
  2. At least two years of Home Health Agency experience and knowledge of documentation standards preferred.
  3. Experience working with various PC based software programs, i.e., Excel, MS Word, etc.
  4. Knowledge of Medicare Home Care and Hospice rules and regulations and governing third party payers.
  5. Excellent interpersonal skills.
  6. Excellent oral and written communication skills.
  7. Excellent organizational and analytical skills.
  8. Positive customer relation skills and the ability to work effectively as a member of interactive teams.

To apply for this job please visit urmhomecare.org.

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