Address
Form of workIn this role you will:
The DME Authorization Coordinator will provide DME operational support to ensure DME, Orthotics, supplies etc., provided to patients meet insurance billing requirements. You will report directly to the Therapy Operations Manager; however, will also be in direct contact with the Director of DME.
Key Responsibilities:
- Provide excellent customer service by handling patient information with discretion during collaboration and communication with external and internal contacts to develop strong relationships.
- Perform Prior Authorization Reviews for our patients of Bone Growth Stimulators and submit to insurance company.
- BGS Clinical review of documentation provided by Physicians to ensure payer guidelines and criteria are met.
- To document Bone Stimulator Benefits and authorization in Athena and internal tracking tools.
- Conducts research to update and maintain Local Coverage Determinations (LCD's) for DME, Orthotics, Supplies etc., and report findings to operation manager and director.
- Assist manager with performing audit of DME claims with modifiers issues to ensure correct assignment to HCPCS codes to receive appropriate reimbursement.
- Assist manager with identifying DME claims with invalid HCPCS codes that have not been processed by payer to verify and implement appropriate billing.
- Responds to questions from managers, billing office, director and others relating to HCPCS and ICD 10 coding, rules and regulations, reimbursement and documentation requirements.
- Assist with the development of DME payer rules and maintaining updates in Athena.
- Pay attention to detail including spelling and grammar while effectively transferring information in a timely and concise manner.
- Reconcile outsourced authorization in FastAuth.
- Assist Manager with compiling medical records for RAC audits.
- Back-up to provide coverage as needed to work or follow through on authorization requests in FastAuth.
- Assist with special projects as determined by DME Manager or Director.
- Assure compliance with all company plans, policies and procedures set forth by the Florida Orthopaedic Institute
- All other duties as assigned
About You:
- High School Diploma
- Minimum 2- 3 years' experience in DME authorization.
- Knowledge of HMO, PPO, POS, Medicare and other Commercial Insurance DME Regulations and guidelines.
- Demonstrates knowledge of HCPCS Level II and CMS guidelines.
- DME Utilization Review experience desired.
- Time-management: Ability to effectively manage one's time and resources to ensure that work is completed efficiently.
- Excellent organizational skills.
- Communication: Ability to provide clear verbal and written information via email, and phone to patients, co-workers, and leadership.
- Critical-Thinking/Decision-making: Ability to choose a course of action or developing appropriate solutions by identifying and understanding issues, problems, and opportunities.
- Ability to work independently with little to no supervision.
- Proficient with Microsoft Word, Excel, Outlook, and PowerPoint required.
- Ability to multitask and manage time effectively.
We Would Love It If You Also Had:
- Associates degree or higher
At FOI our goal is to provide our patients with world-class orthopedic care.
Our mission of providing the best care encompasses not only the care the physician provides, but all medical and administrative aspects of the patients encounter with Florida Orthopaedic Institute (FOI) as well. Every staff member plays a vital role in this mission. We take pride in receiving the Patriot Award from the Department of Defense for the support that we give to National Guard and Reserve members who are employed by FOI. We are committed to encouraging a culture of inclusion reflective of the communities we serve, and we provide equal opportunity to all. Florida Orthopaedic Institute conforms to the spirit as well as to the letter of all applicable laws and regulations.
What we offer:
- Full time opportunities available, with room for career growth and advancement.
- Excellent job security and stability, to promote an optimal work life balance.
- Be part of this dynamic and growing high level Therapy Operations team!
