POSITION GOAL

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

• Pre-certs any DME item as required by insurance companies and Worker’s Compensation: LSO (back braces), ACL (Knee braces) etc….
• Work Bone Growth Stimulator orders by obtaining pre-certs and prior authorizations by calling insurance companies/adjusters/patients, obtains all necessary information required pre-cert or prior authorization to include clinical dictation and test results, Verify benefits, co-pay, deductible and communicate to patients, Appeal denials in a timely manner.
• Organizes clinic claims for electronic or hard copy mail and forwards to appropriate third party payors.
• Reviews claims to make sure that payor specific billing requirements are met, follow up on billing, determines and applies appropriate adjustments, answers questions and updates accounts as necessary.
• Identify front of office claim issues and assist with resolution with current DME processes and workflows for Main and Satellite offices
• Stock and maintain workspace as necessary.
• Reconciles vendor invoices with packing slips for DME
• Manage assigned Payor hold/Manager hold buckets.
• Manage Athena Error Queue
• Assists patients with questions/payments on their accounts.

Experience:

Required:

• 2 years-experience required of medical collections experience Preferred:
• Physician practice setting preferred.

Preferred:

• 5 years of medical office experience
• Previous experience in DME

Education:

Required:

• High school graduate or equivalent

Special Qualifications:

Required:

• Must be able to work independently, have working knowledge of HIPAA requirements and have excellent computer skills.
• Must have knowledge of medical insurance, medical terminology
• Determining eligibility/co-insurance/ copayments and deductibles.
• Must have knowledge of Front and Back End Medical Office Practices
• Must have excellent communication skills both oral and written.
• Must be self-motivated and results oriented.
• Must maintain positive outlook and be highly organized for work assigned.
• Must have ability to multi-task and collaborate positively with other team members.
• Prior Inventory experience a plus.

Preferred:

• CPAR preferred.

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.