SMS-A/R SPECIALIST I

General Purpose of Job:

Responsible for processing claims to payors in order to generate payments to Sparrow Medical Supply for products sold. Supports Accounts Receivable goals and objectives by interacting directly with customers and payors to insure accuracy of claims, meet their needs, relay information, provide instruction, verify insurance coverage and resolve inquiries and issues.

Essential Duties:

This job description is intended to cover the minimum essential duties assigned on a regular basis. Associates may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.

• Processes all components of the billing process, including insurance validation, claim edit list, claims, and re-submissions by using the TIMS database system daily.
• Validates insurance claims by running a daily Validation Report from the TIMS system or DIVER list and completes missing data by referring to the original Customer Service Representative's paperwork.
• Processes a claim edit list weekly from the TIMS system; reviews the list for accuracy and completeness, including social security number and date of birth and quantities of product billed and corrects missing/incorrect information in TIMS system claims file.
• Verifies the appropriate use of modifiers.
• Prints out claims for mailing or electronically sends claim file to payor.
• If a claim is returned or rejected on a payment voucher because of insufficient information, corrects and resubmits claim within 30 days. Documents action in claim file.
• Uses DIVER database system to recover lost claims for resubmission to payor on weekly basis.
• Assists insurance companies or customers with billing questions, inquiries, explanations and provides additional information in writing, if necessary. Documents all conversations and actions taken in TIMS Notes System.
• Works closely with Documentation Specialist for outstanding Certificates of Medical Necessity (CMN's). Communicates when documents are still needed.
• Works with QA Specialist for initial or recert authorizations as required by each insurance.
• Adheres to Corporate Compliance Policies including but not limited to current Medicare/CMS regulations.