Description

SUMMARY:

The Centralized Clinical Documentation Specialist is a telephonic position responsible for collecting wound assessments as needed in order to submit for re-authorization of V.A.C. ® Therapy from insurance companies. The role must secure information about wound progression for patients on V.A.C. ® Therapy and the needed documentation that allows for Acelity to be paid for their services.

Responsible for research, analysis and resolution of high volume, complex customer accounts receivable, order entry exceptions and disputes involving contractual agreements and non-standard billing agreements with hospitals, group purchasing organizations, nursing homes and miscellaneous medical service providers requiring durable medical equipment and associated peripheral medical supplies. Obtain monthly wound progress notes from customer in order to secure subsequent authorization. Maintain customer relationships.

PRIMARY DUTIES/RESPONSIBILITIES:

• Collect wound assessments based on payer requirements

• Assess wound progression for patients on V.A.C. ® Therapy

• Develop and manage customer relationships creating loyalty with Clinical Providers

• Collaborate with other team members to provide continuity of care, resolving higher level account management issues, and communicating physician call support

• Effectively using business and clinical data in accordance with policies

• Meet activity expectation based on past due percentages, aged doc count percentages, and average of assessment submissions

• Identifying additional wounds with designated Post-Acute Clinical Providers

• Providing clinical support and education to Post Acute Clinical Providers

• Reviews, analyzes, and reconciles initial Accounts Receivable and Order Entry exceptions and discrepancies to ensure accurate invoicing and prompt payment within KCI business practice and time sensitive guidelines.

• Performs extended resolution activities on more extensive exceptions and discrepancies including engaging parties such as Finance Department, National Contact Center, Contracts Area and KCI USA field staff to collect necessary transaction details required to advance the resolution process. Utilizes higher-level knowledge of accounts receivable practices and information systems to identify and remove barriers to account collection.

• Facilitates high volume, extensive professional level verbal and written communications to a broad spectrum of internal and external contacts during all resolution activities operating within strict federal credit guidelines and in full compliance with Sarbanes-Oxley regulatory requirements.

• Researches and verifies all requisite specific transactional information such as contractual stipulations and service dates, initial order entry information, purchase order information, contract information such as price breaks, volume commitment levels, current and actual volume levels.

• Practices continual autonomous decision-making based on knowledge and understanding of a variety of contractual pricing structures. Facilitates independent actions to assure purchasing and activities are within stated contractual guidelines including recognizing and complying with various dynamic and goodwill pricing structures.

Skills

clinical, research, medical notes, customer service

Top Skills Details

clinical, research, medical notes, customer service

Additional Skills & Qualifications

REQUIRED QUALIFICATIONS:

• High school diploma / GED or higher from an accredited institution

• Minimum 1-2 year of experience making outbound calls to customers.

• Minimum 2 years of experience working in a medical environment with familiarity in medical terminology, collections, prior authorizations

• Experience with a medical insurance companies

• Ability to review and understand clinical notes/documentation (able to extract needed clinical information for submissions)

• Proficient experience with MS Office applications including Word, Excel, and Outlook

• Demonstrated exceptional customer service skills

• Requires repetitive keyboarding over 95% of the time and phone usage 80% of the time.

OTHER REQUIRED QUALIFICATIONS:

• Demonstrated ability to manage change and multiple priorities

• Demonstrated time management and organizational skills

• Demonstrated ability to operate independently and efficiently, without supervision

• Demonstrated ability to deal effectively with customers, employees and business contacts, while conveying a positive service-oriented attitude

• Demonstrated ability to maintain confidentiality and exercise discretion in all business dealings

• Ability to exercise sound judgment, eliciting support and cooperation from co-workers

• Ability to engage in self-appraisal and continuous learning

• Demonstrated presentation and communication skills

PREFERRED QUALIFICATIONS:

• Fluent in medical terminology and DME

• Experience with a medical insurance companies

Best:

MA certified with recent experience reviewing medical records

Strong understanding of Medical Terminology

Experience Level

Entry Level

Pay and Benefits

The pay range for this position is $19.00 - $19.00

• Medical, dental & vision• Critical Illness, Accident, and Hospital• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available• Life Insurance (Voluntary Life & AD&D for the employee and dependents)• Short and long-term disability• Health Spending Account (HSA)• Transportation benefits• Employee Assistance Program• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a hybrid position in San Antonio,TX.

Application Deadline

This position will be accepting applications until Dec 13, 2024.

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.