Job Summary: The Medical Document Specialist - ASHME manages accurate documentation required to bill revenue for durable medical equipment. Key functions include communicating with providers/personnel on changes in qualifications instructed by CMS, serving as subject matter expert for front end staff, and resolving files for pre-and-post billing audits.

Education: High School Diploma or GED.

Licensure, Registration and/or Certification: None.

Work Experience: 6 months of related experience.

Knowledge, Skills and Abilities: Communication and written interpretation skills. Demonstrated knowledge of Microsoft Word and Excel. Demonstrated knowledge of insurance regulations Knowledge of medical software and terminology

Essential Functions and Responsibilities: Responsible for learning & maintaining CMS regulations for accurate and timely review of qualifying documents for billing. Management of Medicare pre-pay audits, including research, document verification, timely submission, and communication with Medicare audit department. Communicate effectively with providers and patients to educate about and procure accurate documentation for timely billing. Serve as liaison with referral sources and other departments for documentation education. Actively participate in staff education on document management program for successful and timely resolution of all discrepancies by assigned target deadlines. Analysis of data to identify complete and incomplete clinical orders. Audit order and clinical documentation for medically necessity and qualifying information according to patient insurance guidelines to better ensure paid claims. This includes attestation through placement of the billing modifiers KX before claim submission. Responsible for learning and adequately executing industry software in all areas pertaining to documentation, and some areas pertaining to claims as directed. This includes working knowledge of health system EHR software for researching medical necessity. Manages the Certificate of Medical Necessity, including timely delivering and receiving these within the provider community by various methods: fax, secure scan, and in-person delivery. This includes educating referral sources on CMS requirements and changes as they occur. Actively audit all order to increase billing accuracy and decrease claims held for documentation validation. Cooperate with all departments to procure valid documentation as needed. May be responsible for receiving equipment deliveries, and inventory reconciliation.

Decision Making: The carrying out of non-routine procedures under constantly changing conditions, in conformance with general instructions from supervisor.

Working Relationships: Coordinates activities of others (does not supervise). Leads others in same work performed (does not supervise).Works directly with patients and/or customers. Works with internal and external customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above.

Special Job Dimensions: None.

Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

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