Process incoming referrals from referring providers and maintain current status of members in the electronic medical records system.
Disseminate status and missing documentation requirements through the correct reporting mechanisms.
Audit/review medical records database to ensure accuracy and identify areas for improvement.
Success in the role is measured on:
• Ability to update and keep accurate records
• Adjust and modify protocols to meet a changing industry
• Maintaining, updating and keeping accurate department records and communicating this information to all staff, outside providers and agencies.
• Adjusting work process when changes occur to protocols and standard operating procedures in meeting the fluctuating industry standards.
Key Duties & Responsibilities:
• Accept and process referrals from providers for services and enter them into the Electronic Medical Record (EMR) system.
Review and verify data, such as age, name, address, diagnosis, and all information needed for billing and denote deficiencies.
• Verify eligibility in the approved systems from AHCCCS, Managed Care Organizations (MCO’s), Contractors and other funders; at the time of referral and on-going monthly.
• Disseminate reports and correspondence to staff, referring Providers, MCO’s, Contractors and other funders on the status of members and to request updated/required documentation for correct billing.
Knowledge or Experience:
• Knowledge of information needed on referrals in order to have “billable” referrals
• Know the necessary information needed to be entered into the Peer’s EMR in order to generate accurate claims and batches.
• Understand that this is a healthcare and insurance industry and be prepared for market and State changes.
Medical, dental and life insurance paid, plus vision care, 401K and telehealth available.
Minimum Qualifications / Experience:
• Knowledge of data entry and database systems
• Excellent computer skills and time management
• Ability to communicate (in writing and verbally) with various personalities and skill levels in a pleasant and effective manner.
• Valid Arizona Driver License and clear 60 month MVR.
• Pass a background and drug test.
Education / Certifications:
• High school diploma
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