QSM HEALTH SYSTEMS, INC

Responsibilities

Post all payments Medicare FL/NC and Commercial EOB’s, drop statements when needed while posting, ensure claims have been tagged/BB’d & printed, fix “claim processing errors detail report.”

Present Projects:

Review & note all M/care’s denials before giving to appropriate dept

ALL denials from Humana

ALL Humana “Custodial” denials

ALL HMO denials

ALL Medicare’s PR-9; 18, CO140 

Audit accounts that have open claims - investigate, fix and tag.

Do all w/offs on accounts authorized by the Office Manager.

Verify that insurance contracts are up to date & paying at correct fee schedule.

Monthly statements, including sending all letters and accounts to IC System (Collection Agency).

Verify Insurance coverage for providers when out in the field (before office opens).

Review HCFA’s prior to mailing, ensure that charges are entered correctly, attach correct referrals CC pts & Home pts.

Billing:

If original claim comes back denied create claim to correct insurance (e.g., pt becomes hospice or is enrolled with a different insurance company, etc.).

Review all Medicare EOBs for secondary payments.

Enter Secondary Insurance information from Medicare EOB & secondary payment

Do all mail pertaining to patients, review all denials fix and resubmit corrected claims commercial & Medicare PR B9’s, help in the expedition of certain issues, update address and/or make adjustments to return statements.

Past Projects:

Vista & Humana - Resubmit all claims that were unpaid but collected 99%.

Claims - Over 300 claims never printed sent & 98% got paid.

Resubmit any/all Medicare denials listed on the EOB.

Document all reconsiderations, ADRs in pt’s accounts.

Review all denials.

Assist Front Office, ensure patients have the correct balance on account.

Translate Practice forms from English to Spanish.

Become familiar with and abide by all company policies and procedures as set forth by management.

Qualifications

Minimum of Two (2) Years Experience working in a Healthcare Environment. 

Minimum education requirement: High School Diploma, or the equivalent.

*MUST LIVE IN FLORIDA & WILLING TO COMMUTE TO HEADQUARTERS FOR TRAINING *

Note: This is a Remote Position

About Us

Quality Surgical Management (QSM) is the premier wound care provider since 1991. We are currently seeking to fill a full-time position. This position is for an Insurance Verification/Referral Coordinator. We are looking for someone who is ready to join our team of skilled and dedicated staff. This opportunity is for our Hollywood Beach location at 3800 S Ocean Drive Suite 209 Hollywood FL, 33019 in the Hallmark building. Qualified candidates must be detailed oriented and organized, with a strong sense of communication and work ethics.

QSM Health Systems, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

We offer a competitive salary and benefits package which includes health insurance and 401(K) upon completion of the 90-day probationary period. Qualified candidates will be contacted to schedule interviews with our management staff.