Byram Healthcare Clinical Liaison in Huntington Beach, CA at Byram Healthcare

Date Posted: 2/28/2018

Job Snapshot

Job Description



Coordinates and performs all medical record review functions for the Urology product business group.  Reviews patient medical records and communicates information to the correct individuals regarding Medicare Urology Local Coverage Determination (LCD). Medical records review to be performed will include, but not be limited to: medical records for New Accounts receiving Urology products, review of medical records for Medicare Additional Documentation Request (ADR) and Pre-payment Audit submissions, and any other medical record review assigned by management for the purpose of identifying medical necessity associated with the use of the Urology products that are prescribed.


1.       Maintains exemplary levels of customer service in all interactions in accordance to Byram Healthcare's Mission and Vision.

2.       Analyzes and responds appropriately to requests from staff and management regarding denials for services and denials of payment via oral and written communication.

3.       Researches and applies pertinent Medicare and Medicaid regulations to determine the medical necessity of the Urology products that are prescribed

4.       Provides oversight and assistance to staff with resolution by interpreting Medicare and Medicaid regulations

5.       Reviews documentation to ensure medical necessity has been addressed properly and accurately.  

6.       Answers questions from customers, clerical staff, insurance companies, and physician offices.

7.       Identifies and resolves patient complaints.

8.       Performs Quality Assurance phone calls for New Customers to ensure that products are received correctly and are being used appropriately.

9.       Provides guidance to staff members in applying appropriate diagnosis information on new and existing accounts based upon the medical record or verbal information received from outside clinicians.

10.   Performs Clinical Review of Patient Records

11.   Conducts outbound calls to obtain appropriate documentation for reimbursement of orders shipped.

12.   Assists in coordination of obtaining the appropriate medical records to indicate medical necessity upon the request from the payers.

13.   Reviews and approves documentation received by third parties, for submission to payers.

14.   Verifies and obtains any missing information and documents patient insurance information at time of service.

15.   Obtains prior authorization for inpatient and outpatient services from government, commercial, and state agencies, as needed.

16.   Submits timely electronic, verbal notifications, and clinical documentation in accordance with contractual requirements.

17.   Documents activities within ERP system in a clear, accurate and timely manner.

18.   Continuous evaluation, troubleshooting, and feedback of processes and procedures.

19.   Demonstrates critical thinking, research abilities and the ability to work with multiple insurance payers to secure benefits.

20.   Communicates potential issues and trends to Director and initiates resolution steps.

21.   Follows guidelines associated with Byram Healthcare's Policies and Procedures.

22.   Works collaboratively across teams, with peers, and the operations department. 

23.   Performs additional duties as assigned, in support of revenue cycle operations.


1.       Performs additional duties as directed.



  • 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background
  • Current unrestricted Medical Assistant certificate or LVN/LPN license required


  • Ability to comprehend medical policy and criteria to clearly articulate health information
  • Proficient with medical terminology and insurances HCPCS/ICD-9/ICD-10 codes
  • Knowledgeable of Medical Payers and requirements for approvals and payments
  • Proficient in computer software, specifically Microsoft Office (Word, Outlook, Excel, PowerPoint)
  • Ability to communicate clearly and effectively in both verbal and written form
  • Excellent customer service skills
  • Strong interpersonal communication, problem solving and organizational skills
  • Ability to work in fast paced environment
  • Self-directed, and able to prioritize work


  • Little or no travel required (less than 10%)


While performing the duties of this position, the employee is occasionally required to walk, stand, and bend. The employee is also required to constantly speak, key/type, hear, and sit.


This position requires the use of a telephone, calculator, photocopier, file bound, ERP system, computer, and fax machine/scanner.

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