Documentation And Review Specialist

Overview
UnityPoint at Home
Documentation & Review Specialist
Urbandale, IA
Monday-Friday 8:30AM-5:00PM
Full-time + benefits
Reviews all paperwork and patient accounts for accuracy in billing and rental equipment on an ongoing basis and functions as a quality assurance resource to Home Medical Equipment Department. Reviews and manages all necessary documentation needed for billing equipment/supplies to insurance
Why UnityPoint Health? 

• Benefits – Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in. 
• Commitment to our Team – We’ve been named a Top 150 Place to Work in Healthcare 2022 by Becker’s Healthcare for our commitment to our team members. 
• Development – We believe equipping you with support and development opportunities is an essential part of delivering a remarkable employment experience. 
• Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve. 
• Culture – At UnityPoint Health, you matter. Come for a fulfilling career and experience a culture guided by uncompromising values and unwavering belief in doing what's right for the people we serve. 
• Diversity, Equity and Inclusion Commitment – We’re committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation. 

Responsibilities
Essential Functions/Responsibilities:
Essential functions are the duties and responsibilities that are essential to the position (not a task list). o not include if less than 5% of work time is spent on this duty. Be specific without giving explicit instructions on how to perform the task. Do not include duties that are to be performed in the future. Duties should be action oriented and avoid vague or general statements.
% of Time
(annually)
Departmental Support

• Works all incoming payer audits, recording information appropriately.
• Works queues to monitor CMN/SMN hold, authorization hold, qualify status, compliance status to keep revenue hold at a minimum.
• Manages all necessary documentation needed for billing equipment/supplies to insurance. This may include, but is not limited to, SMN/CMN’s, sleep studies, nursing and physician records, authorizations, patient letters and physician letters.
• Serves as the liaison between order entry and billing.
• Specified employees will manage consignment paperwork. This will include patient entry, order and ticket entry, ticket confirmation and review. Some CMN/SMN management will be included in the consignment process.
• Books charges for services/equipment rendered into the system accurately and completely.
• Works the Billing Review queue on a daily basis.
• Meets measures as determined and required for job productivity and performance improvement.
• Works reports and held bills log to monitor accounts on hold due to documentation.
• Reviews all documentation to identify any qualification issues.
• Confirms delivery tickets on a daily basis. Tickets must be entered into system on a timely, consistent manner to allow for prompt payments after money is booked to the system.
• Manages necessary documentation for CHAP and/or FDA requirements such as annual oxygen prescription renewals.
• Reviews and tracks payer audits to provide necessary documentation for payment.
• Reviews all paperwork for accuracy, noting any missing or incomplete data and forwarding to appropriate person for completion when necessary.
• Maintains current knowledge of carrier specific requirements by attending workshops, reading newsletters, and acting as a liaison in carrier meetings and sharing information with other HME personnel.
• Assists with specific aspects of FDA guidelines and current accrediting agency to ensure paperwork meets expectations from these agencies.
• Reviews patient accounts for accuracy in billing and rental equipment on an ongoing basis.
• Functions as a quality assurance resource to HME
• Manages PAP downloads for patient compliance when required.

80 %
Customer Services

• Employee is responsible for completion of communication tasks and activities in a timely manner. This would include, but is not limited to: responding to email, voicemail or telephone messages, promptly, accurately, and professionally; attending staff meetings as scheduled or viewing videotapes of those meetings; asking questions of team members and supervisors when needing clarification about various day-to-day issues or patient needs; and reviewing employee communication pieces to stay aware of UnityPoint at Home programs and initiatives
• Collaborates with management team to identify and prioritize quality improvement strategies that affect company operations.
• Communicates identified problems to appropriate staff to assure follow up is completed to expedite claims and ensure timely and accurate payment.
• Works with HME staff to educate on any documentation updates or concerns
• Follows up with physicians on any delinquent documentation.

10%
Basic UPH Performance Criteria

• Demonstrates ability to meet business needs of department with regular, reliable attendance.
• Employee maintains current licenses and/or certifications required for the position.
• Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.
• Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
• Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.
• Completes all annual education and competency requirements within the calendar year.

10%
Disclaimer: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.
Demonstration of UPH Values and Standards of Behaviors
Consistently demonstrates UnityPoint Health’s values in the performance of job duties and responsibilities
Foster Unity:

• Collaborate across departments, facilities, business units and regions.
• Leverage the skills and abilities of each person to enable great teams.
• Seek to understand and are open to diverse thoughts and perspectives.

Own The Moment:

• Responsible for solving problems regardless of the origin.
• Connect with each person treating them with courtesy, compassion, empathy and respect
• Enthusiastically engage in our work.
• Accountable for our individual actions and our team performance.

Champion Excellence:

• Commit to the best outcomes and highest quality.
• Have a relentless focus on exceeding expectations.
• Believe in sharing our results, learning from our mistakes and celebrating our successes.

Seize Opportunities:

• Have the courage to challenge the status quo.
• Create partnerships that improve care delivery in our communities.
• Embrace and promote innovation and transformation.

Qualifications
Minimum Requirements
Identify items that are minimally required to perform the essential functions of this position.
Preferred Or Specialized
Not required to perform the essential functions of the position.
Education:

• High school or vocational school graduate or an equivalent combination of education and experience.

Experience:

• Knowledge of medical terminology.
• Experience with quality assessment and monitoring activities.
• Ability to understand and apply guidelines, policies and procedures
• Previous HME experience
• Ability to work as a collaborative team member.
• Strong verbal and written communication skills
• Strong interpersonal skills
• Experience using Microsoft Office (Word, Excel)

License(s)/Certification(s):
Knowledge/Skills/Abilities:
Accountability
Communication-written & verbal
Planning and organizing skills
Managing priorities/deadlines
Teamwork
Technical aptitude – ability to learn new systems quickly
Other:
Use of usual and customary equipment used to perform essential functions of the position.

• Job ID: 134784;
• Area of Interest: Patient Care;
• FTE/Hours per pay period: 1;
• Shift: 830a-5p;
• Department: Centralized HME Ops;