Job Application Questions Essay Example | Topics and Well Written Essays - 2250 words

Job Application Questions - Essay Example I respond to daily inquires by telephone and in written correspondence. Most of this communication explains why a claim was denied. To appropriately identify whether a claim was denied in error I reference CPD/CSC desk procedures to research each denial. For instance, if a claim was denied for a code196, surgery not authorized in ASC, I reference the CPD/CSC desk procedures to research whether the code is found in Tricare’s ASC list and in Medicare’s list. I then use the X-code job aide to verify the correct code was used to process the claim. The CHAMPVA policies and regulations are designed to outline the Code of Federal Regulations (CFR). Medicare, Tricare, and CHAMPVA follow rules and regulations listed in the CFR. CHAMPVA follows Tricare’s policy, guidelines, and allowable rates. As a CSR it is important for me to cite various federal codes to providers, sponsors, and beneficiaries. This is especially true when it comes to timely filing, allowable rates, and cost sharing given that these are the areas that are most often appealed. For instance, the Code of Federal Regulations (38 CFR 17.275) outlines a claim filing deadline. With CHAMPVA it is one year from date of service (DOS) for outpatient services but for inpatient services it is one year from discharge date. In the case of retroactive approval, it is 180 days following beneficiary notification of authorization. In the 38 CFR 17.276 outline the appeal and review process for CHAMPVA for claim denials, providers and beneficiaries have one year from denial date to submit an appeal, and 90 days to submit a second level appeal after the initial appeal denial. I use EncoderPro for Internet sufficient research to evaluate sources and appropriately analyze information. To properly answer calls on whether a benefit is covered, using EncoderPro helps me navigate the CHAMPVA policy manual to find the