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

• Reviews all paperwork for accuracy, noting any missing or incomplete data and forwarding to appropriate person for completion when necessary.

• 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.

• Works the Billing Review queue on a daily basis.

• Reviews all documentation to identify any qualification issues.

• Works reports and held bills log to monitor accounts on hold due to documentation.

• Works queues to monitor CMN/SMN hold, authorization hold, qualify status, compliance status to keep revenue hold at a minimum.

• Works all incoming payer audits, recording information appropriately.

• Books charges for services/equipment rendered into the system accurately and completely.

• Assists with specific aspects of FDA guidelines and current accrediting agency to ensure paperwork meets expectations from these agencies.

• Functions as a quality assurance resource to HME

• Reviews patient accounts for accuracy in billing and rental equipment on an ongoing basis.

• 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.

• Manages PAP downloads for patient compliance when required.

• 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.

• Serves as the liaison between order entry and billing.

• 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.

• 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.

• Meets measures as determined and required for job productivity and performance improvement.

Customer Services

• 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

• Collaborates with management team to identify and prioritize quality improvement strategies that affect company operations.

• Follows up with physicians on any delinquent documentation.

• 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

Basic UPH Performance Criteria

• Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.

• 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.

• Completes all annual education and competency requirements within the calendar year.

• 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.

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

• 
  Leverage the skills and abilities of each person to enable great teams.

• Collaborate across departments, facilities, business units and regions.

• Seek to understand and are open to diverse thoughts and perspectives.

Own The Moment:

• 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.

• Responsible for solving problems regardless of the origin.

• 
  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.

• 
  Embrace and promote innovation and transformation.

• Create partnerships that improve care delivery in our communities.

• Have the courage to challenge the status quo.

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:

• 
  Strong interpersonal skills

• Strong verbal and written communication skills

• Ability to work as a collaborative team member.

• Ability to understand and apply guidelines, policies and procedures

• 
  Experience using Microsoft Office (Word, Excel)
• Experience with quality assessment and monitoring activities.
• Previous HME experience
• Knowledge of medical terminology.

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.