Ethan Elmer Email & Phone Number

Ethan Elmer is a Senior Audit Analyst at Lincare Holdings, Inc at Lincare Holdings, Inc. He possess expertise in research, policy analysis, regulatory compliance, legislative testimony, analyst briefings and 7 more skills.

Listed skills include Research, Policy Analysis, Regulatory Compliance, Legislative Testimony, and 8 others.

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  Senior Audit Analyst

  Lincare Holdings, Inc

  Sep 2013 - Present - Kansas City, Missouri Area

  Process, analyze, and respond to Medicare claim audits as they go through Medicare’s formal appeal process while ensuring proper regulation guidelines and time limits have been met throughout the duration of each audit. -Responsible for reviewing medical documentation of beneficiaries represented by Lincare and making determinations for payment in accordance with Medicare’s regulations. -Assess whether services/items billed were reasonable and necessary, supported by national and local policies, and are properly billed and coded with various insurance providers. -Identify areas of insufficient documentation within each claim, if applicable, and take the proper steps needed to obtain the missing documentation in order to ensure payment for each claim is properly met. -Write and submit formal appeal memorandums for each claim after all documentation has been collected, where an outline of all records included is given and an explanation of how they meet all regulatory guidelines is provided. -Coordinate with the Office of Medicare Hearings and Appeals (OMHA) to schedule all ALJ hearings once each claim reaches the final level of the appeal process and establish Lincare’s participation status of each hearing.-Participate in Administrative Law Judge hearings as Lincare’s designated representative, providing testimony for each claim that consists of an oral summarization of all documentation Lincare provided for each patient.-Forecast trends in Medicare denials based upon both an analysis of audits already in process and by researching changes in updated regulations. -Perform post-hearing analysis of all claims once decision letters have been received, identifying areas for improvement and training opportunities.

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  University Of Kansas

  English And Business