Medical Claims & Billing Quality Specialist

Equal Opportunity Employer/Disability/Veterans About Reliable Respiratory Reliable Respiratory is a Durable Medical Equipment (DME) company that provides the highest quality level of service for patients in need of respiratory, diabetes, urology, and maternity support. Equipment provided includes, CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, CGM devices, insulin pumps, and breast pumps. Each patient is treated with professionalism, understanding, and attentive service. We care about our customers, work closely with the medical community, and have highly skilled staff ready to assist customers in receiving the best care possible. The Quality Specialist reviews patient charts and sales orders to ensure information, documentation, prior authorization, and patient eligibility are met to achieve successful payment of claims while providing exceptional service to our patients and their families, payors, providers and team members. Duties and Responsibilities Ensure patient charts are accurate and have all the necessary information. Ensure sales orders are accurate and have all the necessary information. Update patient insurance policies and adjust sales orders as needed. Work with product line teams, providers and patients to obtain necessary and current patient information and medical documentation to ensure timely processing of sales orders. Verify patients’ insurance eligibility, including contacting payors to investigate and verify the terms and benefits of patients’ insurance policies and costs. Perform basic billing functions including but not limited to credit adjustments and recalculation of billing dates of service to ensure sales orders bill correctly. Work with providers and patients to help them understand requirements for payor coverage including but not limited to: Authorization and compliance requirements Appeals for denied services / claims Evaluate and/or escalation patient accounts that do not meet insurance or provider guidelines. Stay up to date on insurance guidelines and their authorization and billing requirements. Actively participate in meetings as necessary. Perform other duties and special projects as assigned and directed. Basic Qualifications 18 years of age or older Must be eligible to work in the United States and not require work authorization from us now or in the future Associate’s degree required or 2 years of relevant (authorization, claims, quality or billing) experience Required Skills Demonstrates effective problem solving. Listens attentively to people’s ideas and concerns. Makes decisions in a timely manner when the options are clear and there is little pressure or risk. Maintains balance through unexpected circumstances. Acts without being asked or required to do so. Exercises excellent judgment in all aspects of the execution of job duties. Effective and professional verbal and written communication abilities. Seeks to improve in all aspects of work performance. Responds to internal and external inquiries in a timely manner. Excellent customer service skills; especially in high intensity situations Strong attention to detail. Proficient in the use of computer applications (especially Microsoft Office Suite). Ability to work independently. Ability to work in collaboration with others. Ability to prioritize and complete work amidst interruptions in a busy work area. Ability to comply with internal and industry-imposed guidelines/regulations Customer Service Ethics Organization Skills Productivity Results Driven Computer Skills Work Environment & 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 communicate and convey information with the appropriate parties. The job requires assuming a stationary position for long periods of time This role routinely uses standard office equipment such as computers, phones, and printers/scanners The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. This job operates in a professional office environment The noise level in the work environment is usually moderate to loud Direct Reports – None Reliable Respiratory, INC participates in E-Verify. E-Verify is a web-based system that allows an employer to determine an employee's eligibility to work in the US using information reported on an employee's Form I-9. The E-Verify system confirms eligibility with both the Social Security Administration (SSA) and Department of Homeland Security (DHS). For more information, please go to the USCIS E-Verify website. #J-18808-Ljbffr Reliable Respiratory