Claims Review Coordinator

**_Join Arizona's largest, most prominent not-for-profit hospice, serving the valley since 1977._** Hospice of the Valley is a national leader in hospice care and has been serving the Phoenix metropolitan area since 1977. A mission-driven, not-for-profit organization, Hospice of the Valley employs compassionate, skilled professionals who are committed to excellence, enjoy teamwork, and contribute daily to our mission and culture of caring. Team members experience a friendly, supportive atmosphere, leadership support, autonomy, flexibility, and the privilege of doing meaningful, rewarding work. **Benefits:** + Supportive work environment with a culture of caring for patients and one another. + Competitive wages and excellent benefit program. + Generous Paid Time Off. + Flexible schedules for work/life balance. **Position Profile** The Claims Review Coordinator is responsible for managing and coordinating the review process of all external medical services received for patients. Provides analysis of data and serves as a subject matter expert related to the adjudication of all external medical claims. Able to implement and streamline processes utilizing technology. **Responsibilities** **Manages the full cycle of all patient expenses that require clinical review.** + Reviews notifications (workflow within EMR, email, and/or provider notification). + Tracks and documents expenses on an Excel tracking spreadsheet within Microsoft Teams (hospitalizations, ambulance, procedures, etc.) + Research patient medical records for notes for orders from the patient's care team or financial review nurse assessment of a claim and determine whether a bill(s) is directly related to the patient's terminal diagnosis. + Requests medical records from the internal medical records team. + Prioritizes and assigns review to Clinical Review Nurses when necessary. + Verifies the accuracy of required information on patient records, such as date of service and level of care; and coordinates with the billing department if any information is inaccurate. + Processes denial letters or payment for claims and attaches to patient records in EMR. + Develop and implement streamlined processes utilizing technology. + Works collaboratively with accounting team to prepare month end accruals for any patient related expenses. **Serves as expert resource for the adjudication of external medical claims.** + Maintains current knowledge of insurance regulations related to hospice billing, including hospice care coverage. + Provides analysis of medical claim expense data and identifies trends; shares with designated HOV leadership. + Prepares ad hoc reports to include but not limited to number of reviews across several months, patient diagnosis, claim diagnosis, care team, etc. + Follows up with Clinical Review Nurse on the status of reviews that are over the established timeframe for processing. **Provides outstanding service and cultivates positive relations with vendors, patients/families and staff.** + Develops and maintains positive working relationships with vendors and other external customers to ensure proper and accurate billing and cooperative problem resolution. + Responds timely to calls regarding patient claims and/or payments. + Reviews and researches any outstanding balances on claims/invoices. + Provides a calm and comforting presence to patients and families via the telephone. + Gives undivided attention and listens carefully to obtain complete and accurate information. + Skillfully navigates patient/family concerns and questions regarding billing. + Responds promptly to patient and family inquiries regarding billing and patient co-pays. + Maintains and enhances professional skills. + Adheres to high standards of personal and professional conduct. **Minimum Qualifications** + Minimum of 3-5 years of experience in billing in utilization review, health care insurance, or billing in a physician's office or hospital. + Knowledge of general healthcare billing practices. + Knowledge of insurance regulations related to hospice healthcare benefits preferred. Hospice of the Valley is an equal employment opportunity employer. EOE/M/F/D/V