DME Authorization Specialist

3 weeks ago

Clearwater, United States Florida Orthopaedic Institute Full time
Job Title: DME Authorizations Coordinator

At Florida Orthopaedic Institute, we are seeking a highly skilled and detail-oriented DME Authorizations Coordinator to join our team.

Job Summary:

The DME Authorizations Coordinator will be responsible for providing excellent customer service by handling patient information with discretion during collaboration and communication with external and internal contacts to develop strong relationships. This role will also perform Prior Authorization Reviews for our patients of Bone Growth Stimulators and submit to insurance company, as well as conduct research to update and maintain Local Coverage Determinations (LCD's) for DME, Orthotics, Supplies etc., and report findings to operation manager and director.

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.
  • Conduct 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.
Requirements:
  • High School Diploma, Associate degree or higher preferred.
  • 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.

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