Hmo Jobs in Tennessee (NOW HIRING)

Essential Duties and Responsibilities:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position. 

• Obtains patient demographic and health insurance information; collects co-pay(s) when appropriate.
• Verifies and records insurance benefits, with the ability to understand and provide insurance breakdowns.
• If required by payer(s), obtains prior authorization &/or follows up on authorization.
• Interacts professionally with physicians, patients, patient’s family, and co-workers.
• Schedules set ups, as called into VieMed, by physicians or physician’s office staff, per policy and procedure.
• Retrieves incoming referral(s) and logs demographic information into current patient database & billing system.
• Reviews medical records from referral(s) to determine if medical necessity has been met.
• Communicates to sales team &/or referral source(s), if referral is acceptable or what is missing to complete referral(s)
• Documents in computer system the status of referral
• Reports all concerns or issues directly to Intake Manager or Intake Supervisor
• Other responsibilities and projects as assigned.

Qualifications

• High School Diploma or equivalent
• One (1) to two (2) years working for a Durable Medical Equipment company or relevant medical office experience preferred.
• Basic understandings of medical insurance benefits
• Skill in establishing and maintaining effective working relationships with other employees, patients, organizations, and the public.
• Effectively communicate with physicians, patients, insurers, colleagues, and staff
• Able to read and understand medical documentation effectively.
• Knowledge and understanding of same and similar DME equipment.
• Knowledge and understanding of In-network vs Out of Network, PPO, HMO
• Thorough understanding and maintaining of medical insurances company’s regulations and requirements to include but not limited to Medicare and Medicaid.
• Working knowledge of CPT, HCPCS & ICD10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits.
• Learns and maintains knowledge of current patient database & billing system.
• Up to date with health information technologies and applications
• Answers telephone in a polite and professional manner. Communicates information to appropriate personnel and management in a timely manner.
• Establishes and maintains effective communication and good working relationships with co-workers, patients, organizations, and the public.
• Proficient in Microsoft Office, including Outlook, Word, and Excel
• Utilizes initiative, strives to maintain steady level of productivity and is self-motivated.
• Work week is Monday through Friday and candidates will work an agreed upon shift (current shifts include 7am-4pm, 8am-5pm, 9am-6pm of 10am-7pm)
• Possible weekend work or overtime, to include working an on-call rotation schedule.

Access to Protected Health Information (PHI)

• This position will require the employee to handle Protected Health Information (PHI) for duties related to document and report preparation. Policies and procedures will be strictly adhered to make sure PHI is protected as required by the HIPAA Privacy Rule.

Working Conditions

• This position will work in an office environment.

We are an equal opportunity employer and all qualified applicants will receive consideration without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other characteristic protected by law.

By submitting your application and participating in the interview process, you acknowledge and consent that interviews, video meetings, phone screenings, and other recruiting interactions may be recorded for evaluation, training, quality assurance, compliance, and hiring purposes. These recordings may be reviewed by authorized company personnel and may be processed using artificial intelligence or automated tools to assist with notetaking, transcription, scheduling, candidate evaluation support, and other recruiting functions. No employment decision will be based on automated processing.  By submitting an application and participating in the interview process, you acknowledge and consent to the recording and processing in accordance with applicable laws and company privacy policies.