Pre-Claim Review Coordinator - ProHealth Home Health and Hospice (Dallas, TX)

Pre-Claim Review Coordinator

A licensed practical/vocational nurse who supports the region with organizing, reviewing, and submitting records for pre-claim review (PCR) for Review Choice Demonstration (RCD) to ensure affirmation. The Pre-Claim Review Coordinator will review all Medicare episodes in assigned RCD state(s) to ensure compliance with regulations and verify necessary components are in place for affirmation and billing.

Qualifications:

• Graduate of a state approved school of practical (vocational) nursing and current state license, or a multi-state license issued by a Nurse Licensure Compact (NLC) member state.
• Two to four years home health experience preferred.
• Knowledge of home health regulations required
• Knowledge of Pre-Claim Review and Review Choice Demonstration preferred
• Able to read, write and comprehend English.
• Organized with a strong attention to detail.
• Strong computer skills, HCHB experience is a plus.

Responsibilities:

• Understands and adheres to established Agency policies and procedures.
• Works closely with Central Intake Department, Intake Manager, and/or Director of Intake, Billing Department, and Regional Director of Operations.
• Understanding of home health practices and terminology.
• Organizes, reviews, and processes pre-claim review workflow to ensure compliance with regulatory requirements and achieve claim affirmation for Medicare billing.
• Reviews each Medicare patient episode to verify that all necessary components are present and coordinates with team members to resolve concerns that would lead to non-affirmation, claim rejection, or claim ADR.
• Organizes submission packets and uploads to government processing provider and tracks status of submissions, affirmations, denials, non-affirmations, etc.
• Responsible for entering tracking number (UTN) into electronic medical record and attaching affirmation letter to client's medical record.
• Serves as a role model for other colleagues by setting an example of high standards in dress, conduct, cooperation, and job performance.
• Observes confidentiality and safeguards all patient related information.
• Accepts responsibility for regular attendance and punctuality; fulfills job-related requirements without regard to time involved.
• Develops a cooperative relationship and communicates effectively with all employees.
• Reports problems and concerns to Supervisor.
• Other duties as assigned by the Regional Director of Operations.

Working Environment:

Works indoors in Agency office/office space

Job Relationships:

Supervised by: Regional Director of Operations

Risk Exposure:

Low Risk

Lifting Requirements:

Ability to perform the following tasks if necessary:

• Ability to participate in physical activity
• Ability to work for extended periods of time while sitting, standing and/or being involved in physical activity.
• Moderate lifting.
• Ability to do moderate bending, lifting, and standing on a regular basis.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.