Billing Representative

SGS Consulting; Eden Prairie (MN); On-site; USD 46,000 - 56,000; Full time

Benefits offered by this job

Paid vacations

Medical insurance

401K savings plan

Life insurance

Disability insurance

Job summary

A Professional Services firm based in New Jersey seeks an individual to manage follow-ups on Certificates of Medical Necessity (CMNs) and prescriptions. The role includes ensuring compliance with regulatory standards and processing renewals. You'll be responsible for documenting account activities and working closely with patients and physicians to facilitate timely reimbursements. If you excel in organized follow-ups and are detail-oriented, this opportunity is for you.

Qualifications

• Experience processing CMNs/prescriptions and provider communications.

Responsibilities

• Perform follow-up on outstanding Certificates of Medical Necessity (CMNs) and prescriptions.
• Maintain follow-up system to confirm actions as per best practices.
• Contact patients to address problems with prescriptions.
• Escalate complex cases to supervisors for resolution.
• Document all activity and ensure compliant documentation.
• Perform accuracy checks to ensure proper reimbursement and compliance.
• Mail prescriptions/CMNs for physician signatures and recordkeeping.
• Identify and communicate errors to supervisors for process improvement.

Skills

Medical Billing

Job description

About US: SGS is a New Jersey headquartered end-to-end Professional Services firm servicing a diverse Fortune clientele. SGS is a Equal Opportunity Employer and prides itself as a employee oriented organization that considers an ensemble of all employee satisfaction elements crucial to organizational and employee growth. We offer a complete range of benefit packages to our employees which includes but is not limited to paid vacations, holidays, personal days, medical insurance, 401K savings plan, life insurance, disability insurance and many other attractive benefits.

Job Description

Duration: 3 Months(temp to perm) (direct offer)

Job Description:

• Performs follow-up on outstanding Certificates of Medical Necessity (CMNs), prescriptions and processes renewal CMNs/prescriptions through the use of suspended billing reports. Maintains and monitors follow up system to confirm that action takes place per Apria "best practices".
• Performs timely follow-up on renewal authorizations to maintain reimbursement activity.
• Contacts patient to gain involvement in problematic situations.
• Elevates aged prescriptions to manager for decision and resolution.
• Evaluates all completed CMNs/prescriptions/authorizations to ensure that the appropriate information has been obtained to allow for reimbursement as well as compliance with applicable standards and regulations.
• Enters CMNs/prescription information into computer once the prescriptions are completed and returned from the physicians.
• Documents all account activity on system. May perform internal quality audits to ensure that all necessary documentation is included in each patient file.
• Processes, reviews and mails prescription and/or CMNs to physicians for signature.
• Provides feedback on errors identified to the appropriate supervisor through the use of the ENF process or other accepted method.
• Researches diagnosis and insurance benefits to receive proper reimbursement.
• Assists in obtaining authorization for reimbursement for some accounts.
• Requests adjustments on accounts and recommends necessary changes to supervisor.
• Complies with and adheres to all regulatory compliance areas, policies and procedures and "best practices".
• Performs other related duties as directed by supervisor.