Exceptional HR Solutions, LLC

General

• Reviews all incoming Release of Information forms and verifies all elements are completed.
• Responds to requests for medical records; processes letters of compliance and reports; answers and directs telephone calls for the Medical Records Department.
• Maintains communication and uploads requests to third party processing vendors.
• Processes records for insurance and billing claims.
• Answers calls from clinic staff pertaining to medical records.
• Keeps direct supervisor informed of problems or issues, monitors supplies needed; performs other duties as assigned.
• Complies with Federal law, HIPAA and 42 CFR Part 2 regulations, in addition to company policies and procedures to maintain the privacy and integrity of protected health information.
• Explains the law and our privacy policy to individuals as needed.
• Maintains appropriate documentation of access to all medical records.
• Other projects and duties as assigned.

Medical Records Clerk – Part Time

• The field-based Community Outreach Coordinator (COC) will work in Spokane at the state level, and at the county/local level where Ideal Option has clinics.
• The COC will work to build awareness of Ideal Option’s services and relationships with organizations and individuals with the goal of generating new patient referrals for treatment, significantly contributing to the opioid response in each community.
• The COC will manage and grow our community partnerships in the Spokane area.
• The COC will use face-to-face outreach, email and phone outreach, community meetings and events, open houses, sponsorships, and field marketing events.
• Develop strategic outreach plans for each community where Ideal Option is located.
• Implement outreach activities and develop and implement partnerships.
• Represent Ideal Option on outside committees, attend conferences and seminars, provide education to individuals and organizations on Ideal Option and medication-assisted treatment.
• Report weekly on community outreach programs and opportunities for community engagement.
• Gather, interpret, and evaluate data to ensure growth objectives are being met.
• Maintain a pipeline of potential partnerships with organizations such as jails, hospitals, inpatient treatment, primary care providers, law enforcement, and behavioral healthcare providers.
• Provide support to community organizations involved in the opioid response or substance misuse prevention.
• Maintain an understanding of local and county government leadership and activities.
• Assess new areas for potential clinic expansion and assist with outreach, location evaluation, and recruitment marketing.
• Supervision and management of one or more peer outreach specialists.

Community Outreach Coordinator

• Proactively monitoring progress of locked and co-signed charts throughout the day
• Call-in or E-fax confirmed prescriptions to pharmacies
• Monitor patient chart activity in eCW for locking and co-signing charts by provider
• Utilized and comprehends eClinicalWorks
• Monitors and tracks established patient prescription authorizations
• Ensures payment of prescriptions by verifying insurance coverage and prescription formularies
• Submits prior authorizations to insurance companies via phone, fax and electronic systems
• Answers incoming calls and addresses patients concerns and/or questions regarding their authorization process
• Maintains accurate documentation of authorizations
• Works directly with insurance companies, pharmacies and providers
• Represents Ideal Option professionally and with a positive attitude
• Complies with national PHI laws including HIPAA and 42 CFR Part 2
• Maintains continual sustained attendance

Prescription Department Specialist

• Submitting medical claims to insurance companies and payers such as Medicare and Medicaid.
• Works directly with the insurance companies, healthcare providers and patients to get a claim processed and paid.
• Reviews and appeals unpaid and denied claims.
• Processes patient and insurance refund requests in a timely manner and posts payments and/or denials from insurance remits.
• Assists patients in getting the correct information to apply for charity/Medicaid or a payment plan.
• Uses coded data to produce sub claims to insurance companies.
• Maintains knowledge of current billing rules and trends for billing types assigned.
• Assists patients in verifying benefit information and assists in patient scheduling and account creation.
• Ensures weekly, monthly, and quarterly department goals are met.
• Obtains referrals and pre-authorizations as required for procedures.
• Checks eligibility and benefits verification for treatments, hospitalizations, and procedures.
• Reviews patient bills for accuracy and completeness and obtaining any missing information.
• Prepares, reviews, and transmits claims using billing software, including electronic and paper claim processing.
• Follows up on unpaid claims within standard billing cycle timeframe.
• Checks each insurance payment for accuracy and compliance with contract discount.
• Calls insurance companies regarding any discrepancy in payments if necessary.
• Identifies any billing secondary or tertiary insurances.
• Sets up patient payment plans and work collection accounts.
• Updates billing software with rate changes.
• Must comply with all elements within HIPAA and the Privacy Act.

Medical Biller

Medical Billing and Coding

• Reviews documentation and assigns appropriate ICD-10, CPT and HCPCS codes.
• Assigns appropriate primary diagnosis after deciding what was chiefly responsible for the encounter.
• Assigns appropriate modifiers according to guidelines.
• Finalizes the appropriate data for accounts.
• Clarifies documentation or diagnosis by communicating with the physician.
• Ensures weekly, monthly, and quarterly department goals are met.
• Makes recommendations to the Billing and Coding Manager for process and quality improvement.
• Maintains knowledge of current coding rules and trends for coding types assigned by attending seminars, workshops and watching webinars.

Medical Records Clerk – Part Time

Community Outreach Coordinator

Prescription Department Specialist

Medical Biller

Medical Coder