(LPN) Pre-Claim Review Coordinator - ProHealth Home Health and Hospice (Pensacola, FL.)

Job Summary

A licensed practical/vocational nurse who supports the region with organizing, reviewing, and submitting records for pre-claim review (PCR) for Review Choice Demonstration (RCD) to ensure affirmation. The Pre-Claim Review Coordinator will review all Medicare episodes in assigned RCD state(s) to ensure compliance with regulations and verify necessary components are in place for affirmation and billing.

Qualifications

• Graduate of a state approved school of practical (vocational) nursing and current state license, or a multi-state license issued by a Nurse Licensure Compact (NLC) member state.
• Two to four years home health experience preferred.
• Knowledge of home health regulations required.
• Knowledge of Pre-Claim Review and Review Choice Demonstration preferred.
• Able to read, write and comprehend English.
• Organized with a strong attention to detail.
• Strong computer skills, HCHB experience is a plus.

Responsibilities

• Understands and adheres to established Agency policies and procedures.
• Works closely with Central Intake Department, Intake Manager, and/or Director of Intake, Billing Department, and Regional Director of Operations.
• Understands home health practices and terminology.
• Organizes, reviews, and processes pre-claim review workflow to ensure compliance with regulatory requirements and achieve claim affirmation for Medicare billing.
• Reviews each Medicare patient episode to verify that all necessary components are present and coordinates with team members to resolve concerns that would lead to non-affirmation, claim rejection, or claim ADR.
• Organizes submission packets and uploads to government processing provider and tracks status of submissions, affirmations, denials, non-affirmations, etc.
• Enters tracking number (UTN) into electronic medical record and attaches affirmation letter to client’s medical record.
• Serves as a role model for other colleagues by setting an example of high standards in dress, conduct, cooperation, and job performance.
• Serves as a role model for other colleagues by setting an example of high standards in dress, conduct, cooperation, and job performance.
• Observes confidentiality and safeguards all patient related information.
• Accepts responsibility for regular attendance and punctuality; fulfills job-related requirements without regard to time involved.
• Develops a cooperative relationship and communicates effectively with all employees.
• Reports problems and concerns to Supervisor.

Working Environment

Works indoors in Agency office/office space

Job Relationships

Supervised by: Regional Director of Operations

Risk Exposure

Low Risk

Lifting Requirements

Ability to perform the following tasks if necessary:

• Ability to participate in physical activity
• Ability to work for extended periods of time while sitting, standing and/or being involved in physical activity.
• Moderate lifting.
• Ability to do moderate bending, lifting, and standing on a regular basis.