The DME office assistant will be responsible for the organization's prior authorization processes and functions relative to outpatient durable medical equipment (DME) and Hospice patients. This job requires expertise in the areas of utilization management, benefit interpretation and insurance regulations/compliance standards. Will work closely with the DME Biller and Brightree Representative to verify coverage for Durable Medical Equipment and work appeals and denials. Will be responsible for verifying benefit coverage and ensuring proper clinical documentation is submitted with all referrals. Will provide back up for front office PSR as needed.

• Maintains current knowledge of applicable CMS, state, local, and regulatory agency requirements and standards related to utilization management, benefit interpretation and insurance compliance guidelines. Tracks patterns and trends of authorization issues from payers to eliminate future delays in authorization processing.
• Ensures proper order, diagnosis and clinical documentation is attached to authorizations. Communicates to medical providers for additional information needed for pending authorizations.
• Obtains DME authorizations, verifies insurance benefits and any out-of-network gap exceptions. Initiates and follows through with authorization appeals. Follows up on all authorization requests in a timely manner and reports on progress to internal teams. Maintains accurate and complete documentation of all inquiries
• Communicates internally and externally regarding authorizations, appeals, exceptions and identified potential issues and concerns. Will assist billing clerk in authorization related billing corrections on rejected or denied claims related to authorization.
• Answers in-bound calls and assists customers.
• Performs other duties as needed.

Values

i - Innovation

"Forward thinking" "Exploring new possibilities" "Ambitious Goals" Looks out for new and innovative approaches that will improve efficiency. Embraces and champions new ideas and encourages others to do likewise. Recognizes and rewards people and teams who are creative and innovative. This is in sharp contrast to those who tend to embrace the status quo, struggle with new approaches and discourage others when they are creative and innovative in the pursuit of increased efficiency or effectiveness.

C - Compassion

"Friendly countenance" "Servant attitude" "Demonstrating genuine concern" Shows genuine sensitivity to the needs, feelings and capabilities of other people. Deals with others in a pleasant manner. Treats others with respect and consideration. This is in contrast to those who are unpleasant and tend to alienate co-workers, or who seem insensitive to the needs of others and tend to demonstrate a lack of respect for others.

A - Accountability

"Showing integrity" "Leading by example" "Ownership and accepting responsibility" Acts in ways that demonstrate personal integrity and serves as a positive example of why others should trust the motives of the organization. Views himself or herself as a reflection of the organization by following through on commitments and accepting ownership of any mistakes he or she might make. Leaves others with the clear impression that integrity is a core value at this organization. This is in contrast to individuals who make commitments that go unmet, fail to acknowledge their role in disappointing events, or whose actions (or inaction) leave others with doubts about the level of trust that should be placed in the organization.

R - Respect

"Considerate of cultural diversity" "Building trust" "All people are to be valued" Demonstrates a genuine interest in the thoughts, opinions, values and needs of co-workers and customers. Avoids speaking, writing or doing other things that could be seen as disrespectful of people in their absence (or "behind their backs"). Recognizes and shows respect for the strengths and contributions of others. This is in clear contrast to behaviors that leave people feeling that their thoughts, opinions, values and needs are of little interest.

E - Empowerment

"Allowing others to reach their full potential: "Freedom to do what is right for our patients" "Attain and share knowledge to enrich others" Empowered in an intentional manner that allows the person to find their way, yet receiving help when needed. Using good judgment related to the level of authority given and the amount of leeway extended. This contrasts with leaders and individuals who focus more on the risks involved from the empowerment, instead of reaching the full potential of the organization.

Organization Expectations

Communication

The process of sending and receiving messages with words, verbally, written or in sign language.

Customer Focus

Identifying and responding to current and future patient and other customers’ needs; providing excellent service to internal and external patients and other customers.

Initiative

Identifying and dealing with issues proactively and persistently; seizing opportunities that arise.

Self-Development

Lifelong, voluntary, and self-motivated learning.

Teamwork

Effectively work and complete assignments in group settings. Works independently and cooperatively with others to achieve common goals.

Skills, Knowledge and Abilities

Intermediate Organization skills

Intermediate Computer skills

Intermediate Communication skills - oral/written

Experience

One year office/clinical experience in a medical setting preferred, or recent training in a similar field.

Education

High School graduate or equivalent.

If you are a current employee or have previously worked for Nor-Lea Hospital District, please contact the Human Resources Department at hrgroup@nlgh.org for your correct username and password.