Job Description

SUMMARY:

This representative will be required to request Medical documentation and assure received documentation meets insurance payer guidelines. When applicable, the audit coordinator will be responsible for accurate and timely response to any audits received.

JOB FUNCTIONS

Must possess excellent communication skills and the ability to practice proper phone and email etiquette,

• Skilled in answering a telephone in a pleasant and helpful manner.

• Ability to read, understand and follow oral and written instructions.

• Proficient with medical terminology and insurances HCPC/ICD-9 codes,

• Documents activities in ERP system in an efficient accurate and timely manner.

• Log and report all received audit inquiries including:

· Prepayment audits/development letters

· Post payment requests for documentation

· Overpayment refund requests

· Medical necessity documentation requests and cert audits

· Billing/coding audits

· Full scale random sampling audits

• Gather and collate all existing documentation required including Proof of Delivery, billing forms, signature attestations, signature authorizations and assignment of benefits, letters of medical necessity, patient logs, etc.

• Review all documentation to be submitted for audit purposes for completeness and accuracy.

• Report to supervisor any apparent issues and coordinate submission of all required documentation.

• Work with billing and collection teams to assure timely submission of all appeals.

• Track and report audit findings and results

• Ability to evaluate and secure the needed Rx’s, PA’s and medical justification to facilitate payment of claims for initial and review/appeals payments.

• Ability to edit and resubmit claims for payment.

• Prepares and reviews clean claims for submission to various insurances either electronically or by paper.

• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule format.

• Proficient in Microsoft Office, particularly Word, Excel and Outlook.

• Provide feedback to Group Team Lead regarding issues regarding accounts.

Company Description

Byram has been a national leader in disposable medical supply delivery since 1968. Byram provides quality supplies, services, and support, specializing in diabetes supplies, ostomy supplies, wound care supplies, urology supplies, incontinence supplies, and enteral nutrition products. In 2017, Byram was acquired by Owens & Minor (NYSE: OMI), a global healthcare services company, to expand the organization’s ability to serve the continuum of care in the patient’s home. Byram Healthcare, an Owens & Minor company, is more prepared than ever to tackle the challenging, changing healthcare landscape. Byram Healthcare is here to deliver the products, services, and support needed to maximize clinical outcomes and manage complicated benefits.