Claims Review Coordinator
Phoenix-AZ-85001-United States
Join Arizona’s largest, most prominent not-for-profit hospice, serving the valley since 1977.
Hospice of the Valley is a national leader in hospice care and has been serving the Phoenix metropolitan area since 1977. A mission-driven, not-for-profit organization, Hospice of the Valley employs compassionate, skilled professionals who are committed to excellence, enjoy teamwork, and contribute daily to our mission and culture of caring. Team members experience a friendly, supportive atmosphere, leadership support, autonomy, flexibility, and the privilege of doing meaningful, rewarding work.
Benefits:
- Supportive work environment with a culture of caring for patients and one another.
- Competitive wages and excellent benefit program.
- Generous Paid Time Off.
- Flexible schedules for work/life balance.
Position Profile
The Claims Review Coordinator is responsible for managing and coordinating the review process of all external medical services received for patients. Provides analysis of data and serves as a subject matter expert related to the adjudication of all external medical claims. Able to implement and streamline processes utilizing technology.
Responsibilities
Manages the full cycle of all patient expenses that require clinical review.
- Reviews notifications (workflow within EMR, email, and/or provider notification).
- Tracks and documents expenses on an Excel tracking spreadsheet within Microsoft Teams (hospitalizations, ambulance, procedures, etc.)
- Research patient medical records for notes for orders from the patient’s care team or financial review nurse assessment of a claim and determine whether a bill(s) is directly related to the patient’s terminal diagnosis.
- Requests medical records from the internal medical records team.
- Prioritizes and assigns review to Clinical Review Nurses when necessary.
- Verifies the accuracy of required information on patient records, such as date of service and level of care; and coordinates with the billing department if any information is inaccurate.
- Processes denial letters or payment for claims and attaches to patient records in EMR.
- Develop and implement streamlined processes utilizing technology.
- Works collaboratively with accounting team to prepare month end accruals for any patient related expenses.
Serves as expert resource for the adjudication of external medical claims.
- Maintains current knowledge of insurance regulations related to hospice billing, including hospice care coverage.
- Provides analysis of medical claim expense data and identifies trends; shares with designated HOV leadership.
- Prepares ad hoc reports to include but not limited to number of reviews across several months, patient diagnosis, claim diagnosis, care team, etc.
- Follows up with Clinical Review Nurse on the status of reviews that are over the established timeframe for processing.
Provides outstanding service and cultivates positive relations with vendors, patients/families and staff.
- Develops and maintains positive working relationships with vendors and other external customers to ensure proper and accurate billing and cooperative problem resolution.
- Responds timely to calls regarding patient claims and/or payments.
- Reviews and researches any outstanding balances on claims/invoices.
- Provides a calm and comforting presence to patients and families via the telephone.
- Gives undivided attention and listens carefully to obtain complete and accurate information.
- Skillfully navigates patient/family concerns and questions regarding billing.
- Responds promptly to patient and family inquiries regarding billing and patient co-pays.
- Maintains and enhances professional skills.
- Adheres to high standards of personal and professional conduct.
Minimum Qualifications
- Minimum of 3–5 years of experience in billing in utilization review, health care insurance, or billing in a physician's office or hospital.
- Knowledge of general healthcare billing practices.
- Knowledge of insurance regulations related to hospice healthcare benefits preferred.
Hospice of the Valley is an equal employment opportunity employer. EOE/M/F/D/V
PI276443009
