HEALTH INFORMATION SPECIALIST (HIS)

Duties :

• Review and understand Insurance policies and standard Explanation of Benefits.
• Review and understand medical documentation effectively.
• Review and resolve request for medical records, related to
• Claims processing
• Internal and external audits
• Authorized external entities
• Monitors & maintains audit logs.
• Performs internal audits for quality assurance.
• Responsible for managing medical records of patients for insurance, private individuals and / or Government entities for home medical equipment.
• Establishes and maintains effective communication and good working relationships with patients / family, physicians' offices, and other internal teams for the patient's benefit.
• Performs other clerical tasks as needed, such as
• Answering patient / Insurance calls
• Faxing and Emails
• Communicates appropriately and clearly to Manager / Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor
• Other responsibilities and projects as assigned.

Requirements :

• High School Diploma or equivalent
• Knowledge of Explanation of Benefits from insurance companies
• Working knowledge of government, regulatory billing and compliance regulations / policies for Medicare & Medicaid
• Working knowledge of CPT and ICD-10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits.
• Knowledge of policies and procedures to accurately answer questions from internal and external customers.
• Utilizes initiative while maintaining set levels of productivity with consistent accuracy.

Experience :

• Minimum of 2 Years in DME experience required
• 3-5 Years in DME or medical billing experience preferred

Skills :

• Superior organizational skills.
• Proficient in Microsoft Office, including Outlook, Word, and Excel.
• Attention to detail and accuracy.
• Effective / professional communication skills (written and oral)

Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.

However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)