- BILLING OF THIRD PARTY CLAIMS - Create newly discovered Other Health Insurance (OHI) claims via TPOCS. Utilize the CHCS system to gather information necessary to manually create a Third Party claim. Utilize TPOCS and manually populate the information gathered from CHCS to create a claim. Maintain a log of back bills for new OHI discovery. Generate compile and prepare Uniform Business Office (UBO) reports to be entered in the UBO Metrics and submit to higher authority. Reconcile TPC Program accounts and reporting records. Ensure TPC documents indicating amounts paid or collected equals amounts deposited. Ensure TPC records are reconciled with TPC deposits and reports including DD Form 2570 report. The TPC records shall be reconciled monthly with accounting and finance office records
- POSTING OF PAYMENTS AND DENIALS - Utilize TPOCS to post checks and denials received from the insurance carriers. Research in TPOCS and CHCS for bill control number and other pertinent information before posting is done.
- INSURANCE VERIFICATION - When the patient completes the DD2569 form, contract employee will verify the patient’s insurance coverage through various resources (telephone, websites, etc).
- Obtain (via phone, in-person and/or written correspondence) all relevant information regarding Other Health Insurance (OHI) from active duty dependents, retirees, and retiree family members as they present themselves at the Medical Treatment Facility for care/services and at the Pharmacy for prescription services. Ensure all pertinent data elements on the DD 2569 Other Health Insurance form are accurately completed. Scan DD 2569 into contractor’s database and file original copy into member’s medical record. Utilize the DOD medical systems to perform the OHI data entry function requirement application in the Composite Health Care System (CHCS) in use at the MTF. Contractors may be required to attend staff training related to Other Health Insurance. Support shall include filing, copying and mailing of various documents.
SKILLS AND KNOWLEDGE REQUIRED FOR THE POSITION
- Able to read, write, speak, and understand English; able to communicate in a professional manner (written & oral)
- Experience in high level customer service, medical billing, knowledge of insurance plans and terminology
- Knowledge of correspondence rules and regulations
- Able to interpret and apply regulations and procedures
- Knowledge of communications/graphics/word processing software functions, processes and capabilities
- Knowledge of the OHI data entry function requirement application in the CHCS
- Thorough familiarity with health insurance industry practices
- As a minimum, possess a business-professional level of written correspondence
- Basic knowledge of how to use a personal computer/ laptop
- Shall comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirement
- Able to follow instructions and complete tasks assigned by the OHI Project Manager and Uniform Business Office Manager
- Knowledge of the Defense Enrollment Eligibility Reporting System (DEERS), Composite Health Care System (CHCS/AHLTA)
- General knowledge of Medical Service Accounts, DOD MSA, TPC and TPL processes.
- Microsoft Access and Excel knowledge
- Knowledge of or the ability to learn, utilize and apply, and adhere to guidelines found in the following documents:
- DoD 6010.15-M, Military Treatment Facilities (MTF) UBO Manual, current version
- 32 Code of Federal Regulation (CFR), Part 220
- Third Party Outpatient Collection System (TPOCS) Users Guide, current version
