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Founded in 1991, The SCOOTER Store is headquartered in New Braunfels, Texas and has locations and a network of service specialists across America. The SCOOTER Store has grown from a vision into a highly successful national enterprise with over 2,200 employee-owners.
The SCOOTER Store maintains strict compliance with Medicare regulations and works through the Power Mobility Coalition to ensure the availability of additional consumer safeguards and industry standards such as ongoing customer service and product maintenance. The SCOOTER Store is accredited by the Accreditation Commission for Health Care, Inc. (ACHC).
Summary: Oversight and accountability for assigned denied claims from the beginning of the Appeals Process to the end. Responsible for researching, and administering Redetermination, Reconsiderations, and ALJ Requests and Confirmations. Proactively implements recommendations for appeals arguments coordinating with the Supervisor of Appeals and the Medicare Appeals Officer. Reviews each denial/appeal for proper billing, compliance to all Medicare regulations and ensures that documentation provides support for medical necessity. Maintains all eQueue follow up dates and statuses to ensure timely filing of all Appeals Requests. Determines viability of claims and when appropriate, makes the determination to be written off or dismissed.
Essential Duties and Responsibilities:
• Reviews all denied claims at each stage of the Appeals Process and confirms billing procedure, compliance to Medicare regulations and support for medical necessity.
• In cases where additional medical documentation is needed, coordinates with the physician’s office, hospital, home health care or other specialists to obtain necessary documentation.
• Prepares Nurse file with required documentation for clinician preparation of Repudiation.
• Researches and consults with Management regarding arguments for all Redeterminations, Reconsiderations and ALJ Requests. Implements decisions from management.
• Confirms receipt of all Appeals Requests with Medicare.
• Coordinates with the Judicial Support group completion of all ALJ files for legal presentation.
• Contacts customer to obtain additional information, when necessary.
• Contacts Medicare to obtain additional information or resolve Medicare errors, when necessary
• Maintains all eQueue follow up dates and statuses to ensure timely filing of all Appeals Requests.
• Follows up with Medicare on all Favorable decisions to ensure prompt payment of claims.
• Consults with management and prepares all write offs and dismissals.
• Must meet or exceed all performance standards.
• Must maintain professional behavior at all times
Education and/or Experience: High school diploma or general education degree (GED) and some college; and three to five years related experience and/or training; or equivalent combination of education and experience.
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Medicare or medical background experience
• Above average knowledge of Medicare and third party payers regulations, policies, and compliance issues
• Familiar with medical terminology and ICD-9 codes
• Familiar with Medicare and/or third party payer appeals processes
• Able to multi-task and handle large diverse workload
• Above average problem solving ability
• Can handle moderately complex projects/assignments
• Read and interpret less straightforward material such as activity reports, procedure manuals, and non-standard letters
• Write short notes, brief memos or instructions
• Perform simple math functions, such as counting, adding, subtracting, multiplying, or dividing
• Use spreadsheet, database, work processing or financial software to enter, edit or retrieve data
Other Knowledge, Skills and Abilities:
• Must have strong organizational skills and be able to collect data, establish facts, define problems and determine solutions with limited supervision
• Must have solid time management skills
• Must have attention to detail
• Type 35 WPM minimum
• Proficient in Microsoft Office applications
• Excellent communication skills, both oral and written
• Must be willing to adapt to changing conditions in dealing with Medicare as the rules frequently change.
In return for your experience, The SCOOTER Store offers a competitive salary and a generous benefits package.
The SCOOTER Store World Headquarters, Distribution Centers, and Stores are tobacco-free facilities.
The SCOOTER Store is an Equal Opportunity Employer.
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