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Medicare Interviewer - Saint Paul MN
Company: AppleOne
Location: Saint Paul, MN
Posted On: 11/03/2009
Medicare Utilization
Reports to: Medicare Specialist Supervisor
JOB SUMMARY
Based on clinical experience, evaluates patient, payer, and diagnosis information to coordinate and triage file for reimbursement.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Contact patients within 7 days to discuss payer denial, appeal strategy and communicate patient responsibilities in the appeal process.
Interview patients regarding medical history for justification of medical necessity of products according to Medicare guidelines.
Document file activity in the database as it occurs.
Contact other medical professionals and gather additional documentation to support policy criteria or payer strategy.
Work with internal departments to strategize appropriate process changes in supporting Medicare Clinical Review and Medicare Appeals.
Assess cases, develop strategies and set timelines to ensure deadlines are met.
Identify appropriate files resolution.
Initiate the pick-up process, when necessary
QUALIFICATIONS
Licensed LPN, or Respiratory Therapist
- Current professional licensure or certification, as required by the state of residence
- 1-3 years of clinical pulmonary experience in a hospital, healthcare or homecare setting
Third Party experience with Medicare/Third party payer.
Knowledge of federal, state, and local regulations, guidelines, and standards, including a working knowledge of HIPAA rules and regulations
Proven excellent verbal and written English language skills both up and down the organization as well as externally with customers, payors and patients
Strong organizational skills
Ability to prioritize workflow; organize schedule; meet deadlines
Customer service oriented
Preferred:
Knowledge of Medicare Regulations
Computer Skills:
Microsoft Office
Lotus Notes
JDE
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