The rewards at Healogics are immense, starting with the important work we do to change patients’ lives. We also understand that meaningful work is hard work, and we are committed to supporting and compensating our employees for the tremendous service they provide.
 

Think you are a great fit? Learn more about this role here:

Healogics Wound Care Supply, LLC (“HWCS”) is a subsidiary entity of Healogics, LLC (“Healogics”) who is the largest provider of advanced wound care services in the United States, treating more than 300,000 chronic wound patients annually across over 600 sites. With an aging society, obesity and diabetes on the rise, and an uptick in surgical procedures, the number of patients with non-healing wounds that would benefit from expert care is dramatically increasing. As a result, Healogics – via its family of companies - is working to provide our differentiated, quality outcomes to as many patients that would benefit through our out-patient clinic partnerships.

The Senior Account Representative is a member of HWCS’ Healogics Documentation Team who works closely with outside vendors and / or customers as well as internal HWCS staff and employees of other Healogics entities. The duties and responsibilities of the Senior Account Representative include analysis of medical records for each of our product lines to support daily claims analysis and “scrubbing” of claims against relevant payor criteria for coverage. This includes Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) associated with Medicare and its Medicare Administrative Contractors (MACs) as well as coverage guidance provided by other governmental payors and private payor entities. Senior Account Representative is responsible for collection, validation, and analysis of patient information applicable to specific DME or other supply orders and referencing internal and external guidance material which identifies documentation necessary from the medical record for “scrubbing” of the claim associated with the order. The Senior Account Representative is also responsible for reconciliation of “missing documentation” reports for claims under review and education of clinical staff and patient navigators with respect to why said information necessary for the review of a particular claim. From time to time, the Senior Account Representative also will be required to compile data and otherwise assist in reporting and auditing related to activities of the Healogics Documentation Team.

In addition, the Senior Account Representative will manage a territory of Centers for HWCS. Will conduct quarterly business reviews with HWCS Leadership on key performance indicators of the business. Will build relationships with staff and providers of territory to create high satisfaction of our services.

Due to the requirement to routinely access medical records, this position requires a familiarity and compliance with the Health Insurance Portability and Accountability Act (“HIPAA”) as well as similar state laws. This position requires a general familiarity with electronic medical record (“EMR”) systems. Healogics has its own EMR system – i-heal. Training specific as to the use of this system will be provided.

Essential Functions/Responsibilities:  

Review order packets for DME or supplies Confirm relevant payor for the order. Confirm documentation provided is complete based on the requirements of the payor and DME / supply ordered.

Engage in formal and informal education to wound care center-based staff, including patient navigators, case managers, clinical nurse managers, and providers as to documentation and data necessary for review of DME / supply orders based on the coverage requirements of specific payors. Types of data required by a payor to process a DME / supply order is missing from documentation, i.e., progress notes or wound assessments missing data such as duration of need, quantity used per day, total quantity used, etc.

Create presentations around territories key performance indicators and show goals achieved and educational action plans to train on consistent compliant documentation. 

Upload and maintain collected analysis and determination documents in HWCS’ Documentation Repository System.

Provide routine follow-up to wound care center-based staff to advise of metrics related to initial completeness of documentation for order packets received as well as validation rate for medical necessity requirements.

Assist with departmental audits as well as vendor or customer audits.

Follow all confidentiality and security requirements as to medical records.

Follow all documentation and tracking requirements related to records requests to allow for data analysis of program efficacy and efficiency.

Complete administrative duties including answering phones, taking messages, responding to emails, communicating information back to vendors / customers, maintaining necessary logs, and collaborating with fellow team members.

Participate in improving quality throughout the company and the Healogics organization.

Perform other duties as required.

Required Education, Experience and Credentials:

Bachelor’s degree from an accredited university or college in business, accounting, finance, healthcare administration required or related field or equivalent experience

Minimum of four (4) to six (6) years related experience in health care finance and/or revenue cycle in hospital, physician office or., other related setting. 

Required Knowledge, Skills and Abilities:

Working knowledge of DME coding, billing, payor requirements, and denial management.

Must have a working knowledge of the Medicare and MAC codes, rules, regulations, pronouncements and applicable Fiscal Intermediary policies (e.g. Local Coverage Determinations).

Familiarity with medical terminology.

Proficient in Microsoft Suite (Excel, Word, Outlook).

Keen attention to detail with the ability to work independently and maintain confidentiality.

Ability to collaborate and demonstrate leadership skills in a team environment.

Strong interpersonal, written and verbal communication skills with a focus on customer service.

Organization, prioritization and time management skills.

Working knowledge of systems/applications with indication of those preferred.

Demonstrated ability to exhibit integrity and commitment to professional ethics.

Budget and long-term planning skills.

This range is an estimate, based on potential employee qualifications: education, experience, geography as well as operational needs and other considerations permitted by law. 

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