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DME Precertification/Reimbursement Analyst Full Time
This position will support proper maintenance of the DME Department by performance of administrative functions/tasks. Maintains overall understanding of payors to include what is covered versus non-covered. Serves as a liaison between clinic, patients and payors.
Position Responsibilities:
- Write up tickets for DME dispensing
- Reconciles vendor invoices with packing slips for DME as needed.
- Identify issues and resolve with DME processes and workflows for Main and Satellite offices
- Work Bone Growth Stimulator orders by obtaining pre-certs and prior authorizations by calling insurance companies/adjusters/patients. Obtain all necessary information required for pre-cert or prior authorization, including clinical dictation and test results. Verify benefits, co-pay, deductible and communicate to patients. Appeal denials in a timely manner.
- Pre-certs any DME item as required by insurance companies and Worker’s Compensation: LSO (back braces), ACL (Knee braces) etc.
- Stock and maintain workspace as necessary.
- Responsible for ordering and maintaining appropriate inventory levels as needed.
- Organizes clinic claims for electronic or hard copy mail and forwards to appropriate third party payors.
- Reviews claims to ensure that payor specific billing requirements are met, follow up on billing, determines and applies appropriate adjustments, answers questions and updates accounts as necessary.
- Assist DME Manager with assigned Payor hold/Manager hold buckets.
- Assist DME Manager concerning patients with questions/payments on their accounts.
- Appropriately appeal insurance claims in a timely manner.
- Research and write up refunds.
Experience:
Required:
- Two years’ experience in medical collections.
- One year front-end medical office experience (patient payments, demographic to file the claim) as well as back office billing experience (the filing and follow up of the claim).
Preferred:
Education: High School diploma or equivalent required.
Special Qualifications:
Required:
- Proficient in the following areas: insurance/claims processing, posting, modifier use, and understanding of EOB’s, navigation of payor sites, HCFA/UB, determining eligibility/co-insurance/copayments and deductibles.
- Ability to work independently.
- Working knowledge of HIPAA requirements.
- Excellent communication skills both oral and written.
- Self-motivated and results oriented.
- Maintain positive outlook and be highly organized for work assigned.
- Ability to multi-task and collaborate positively with other team members.
Preferred:
- Prior Inventory experience and Medical Terminology.
The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.
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