Graham Healthcare Group

QA Engineer

• Responsible for quality-driven review of documentation of care center staff members, including the Comprehensive Admission Assessment, starts of care, Certification of Terminal Illness, HIS and other related documents, ensuring appropriateness of care, delivery and documentation requirements are met.
• Ensures the assignment of the appropriate clinical pathways on the plan of care
• Ensures missing, incomplete, and/or untimely documentation issues are resolved.
• Ensures benefit periods are assigned accurately.
• Ensures communication of changes in the plan of care are documented completely and correctly.
• Participates in quality assurance activities designed to improve the quality and continuity of patient care.
• Performs chart audits and other activities of data collection.
• Responds to Additional Documentation Requests/Denials as directed.
• Performs chart audits as directed to monitor documentation and patient clinical records to ensure compliance with agencies policies and procedures and all regulatory inspection agencies.
• Keeps abreast of nursing trends and knowledge.
• Exceptional attention to detail
• Strong knowledge of regulatory guidelines and best practices
• Focused Quality attention
• Performs other related duties as assigned or requested.
• Demonstrates initiative and skills in planning and organizing work.
• Cooperates with scheduling requests to meet department needs.
• Demonstrates a desire to set and meet objectives and to find increasingly efficient ways to perform tasks.
• Completes work with accuracy and within department time frames.
• Is flexible to changes in duties and responsibilities.

Quality Assurance Registered Nurse

Billing Specialist

• Support Billing Management to ensure timely and correct claims are filed with all respective payers and intermediaries
• Monitor claims for timely processing of payments and rejections and work A/R on a weekly basis
• Perform claim audit review for Medicare and PDGM Medicare Commercial
• Work the Medicare/Medicare PDGM Claims Held workflow
• Maintain responsibility for Oasis reports
• Review unbilled reports for Medicare and Non-Medicare on a weekly basis
• Bill Medicare/Non-Medicare claims on a daily basis
• Review pre-post report to verify all visits have a usual and customary rate and contractual adjustment on a bi-weekly basis
• Work Medicare/Non-Medicare claim rejections
• Perform billing note entry on all outstanding accounts over 30 days
• Make insurance calls to check status on outstanding claims
• Process requests for additional information from Insurance Companies
• Answer billing queue calls
• Collect patient payments via the phone
• Work monthly Medicare, Medicare, HMO, and 3rd-party agencies
• Review Monthly SOX report to ensure every account over 30 days has a Billing note
• Cover department when other employees are ill or on vacation
• Duties may vary depending on which insurance team the employee is on
• Comply with Company’s Core Values and Core Competencies
• Perform other duties as assigned by supervisor

Home Health Billing Analyst I

• Meet quality and productivity standards and deadlines/turnaround times established by Hospice
• Perform daily HCHB workflow maintenance to ensure the medical record is compliant and up to date
• Review and compare daily reports to clinical staff documentation
• Review Medicare Part D response and denials documents and collaborate with the physician and clinical supervisors for accuracy
• Maintain working knowledge of Brand and Generic Medications for Hospice Patients and work collaboratively with Part D Sponsors to ensure correct payment for medications
• Collaborate with the Billing Department to ensure claims are complete with the appropriate medications.
• Perform claim medication review and entry of claim medications into the medical record
• Perform data entry of medications dispensed by the pharmacy and monitor the HCHB interface
• Ensure accurate and timely submission of HIS data and keep current on changing rules and regulations as related to HIS
• Communicate with the various insurance companies to ensure proper processes are being met, and ensure payments are correct
• Assist, when necessary, with planning and scheduling face-to-face visits with Nurse Practitioners and Hospice physicians to maintain compliance
• Perform Quality Assurance audits as directed

Quality Assurance Registered Nurse

Home Health Billing Analyst I

Hospice Quality Assurance Administrator