Clinical Liaison in Huntington Beach, CA at Byram Healthcare

Date Posted: 4/26/2018

Job Snapshot

Job Description

The Clinical Liaison will coordinate and perform all medical records review functions for our Urology product business group.  This position will review patient medical records and communicate 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. The Clinical Liaison will be responsible for  analyzing and responding appropriately to requests from staff and management regarding denials for services and denials of payment via oral and written communication; researching and applying pertinent Medicare and Medicaid regulations to determine the medical necessity of the Urology products that are prescribed;  provide oversight and assistance to staff with resolution by interpreting Medicare and Medicaid regulations;  reviewing documentation to ensure medical necessity has been addressed properly and accurately. 

  • Responsible for maintaining exemplary levels of customer service in all interaction in accordance to Byram Healthcares Mission and Vision.
    • Answers questions from customers, clerical staff, insurance companies, and physician offices.
    • Identifies and resolves patient complaints.
    • Performs Quality Assurance phone calls for New Customers to ensure that products are received correctly and are being used appropriately.
    • Provides guidance to staff members in applying appropriate diagnosis information on new and existing accounts based upon the medical record or verbal information we have received from outside clinicians.
  • Performs Clinical Review of Patient Records
    • Conducts outbound calls to obtain appropriate documentation for reimbursement of orders shipped.
    • Assists in coordination of obtaining the appropriate medical records to indicate medical necessity upon the request from the payers.
    • Reviews and approves documentation received by third parties, for submission to payers.
    • Verifies, and obtains any missing information and documents patient insurance information at time of service.
    • Obtains prior authorization for inpatient and outpatient services from government, commercial, and state agencies, as needed.
    • Submits timely electronic, verbal notifications, and clinical documentation in accordance with contractual requirements.
    • Documents activities within ERP system in a clear, accurate and timely manner.
  • Continuous evaluation, troubleshooting, and feedback of processes and procedures.
    • Demonstrates critical thinking, research abilities and the ability to work with multiple insurance payers to secure benefits.
    • Communicates potential issues and trends to Director and initiates resolution steps.
    • Responsible for following guidelines associated with Byram Healthcares Policies and Procedures.
    • Works collaboratively across teams, with peers, and the operations department. 
Performs additional duties as assigned, in support of revenue cycle and customer service operations

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