Patient’s Choice, a fast growing (DME) Durable Medical Equipment company, specializing in mobility and therapy products, is looking a new member of our reimbursement team in the DME arena. The company was founded in 2007, with headquarters in Arlington Heights, IL (Chicago/Northwest Suburbs).
Responsible for review of Physician Orders, Detailed Product Descriptions and Clinical Record Documentation for Durable Medical Equipment, including telephone support, data entry, submission to the Health plans for medical necessity review, completion of service authorization detail lines, and member/ provider notification process.
- Responsible for pre-certification Durable Medical Equipment and selected outpatient therapies.
- Follows departmental workflow for prior authorization of request, including documenting receipt of request, member eligibility, submitted information in the internal systems.
- Authorizes services based on Plan Guidelines. If unable to approve, submits the request to Review Committee for medical necessity determination.
- Completes detail lines in internal systems to reflect authorization or denial of services.
- Works closely with the Sales Representatives to gather all medical necessity documentation to approve delivery of Durable Medical Equipment.
- Tracks all additional documentation requests and Prior Authorization Requests
- Provides information regarding customer’s coverage issues, private pay options, and insurance billing
- Calculates Profit Margin on all Complex Rehab Orders Ensures order setup accuracy for proper reimbursement
- Maintains current knowledge on Medicare, Medicaid, and third-party payer sources for equipment coverage
- Submits appeals to insurance companies as necessary Schedules/Routes all deliveries & repairs
EXPERIENCE & EDUCATION
- Some College Preferred or Experience in DME
- Minimum 2 years of experience with a pre-certification and re-certification process for outpatient therapies and Durable Medical Equipment within a Home Health agency, medical equipment company or managed care organization.
- Proficiency with Microsoft Office Suite (Word, Excel, Power Point).
- Experience with ICD-10.
- Demonstrated proficiency utilizing MS Office, electronic medical record and documentation programs within a Windows based environment.
- Salary is commensurate with experience
- Medical and Dental (after 90 days) – Full Time (pending full time status)
- 401K - Full Time (pending full time status)
- FSA – Flexible Spending Account – (pending full time status)
- Vacation and Holidays (pending full time status)
We look forward to meeting serious candidates that have worked with Medicare/Medicaid and has to aptitude to continue to learn in this changing DME environment. Thank you for reviewing this ad and look forward to potentially meeting you in person.
Patients Choice Management