Job Description

DME Insurance Reimbursement

ENTRY REQUIREMENTS Education:

• Associates Degree or 2 years formal education. • Medical Terminology required or successful completion of medical terminology course within 90 days of hire. • Knowledge of current third-party payer reimbursement rules required.

Work Experience:

• Minimum of 3 years of related experience in Home Medical Equipment

Keyboard - Computer Skills:

• Advanced keyboard, mouse, computer and Microsoft Office skills. Must have knowledge and ability to learn, access and utilize the computer programs listed below within 90 days of hire. o Outlook o Star o Insurance Verification systems o Smart Web o Power Chart o Brightree

Other Entry Requirements: • Strong interpersonal, technical, and written/verbal communication skills; ability to interact effectively at all levels of the organization. • Ability to demonstrate effective communication with Insurance companies to obtain, verify, and create accurate documentation with information gathered. • Must demonstrate ability to adapt to change and keep up with continued advanced education requirements. • Must possess strong analytical and interpretative skills. ORGANIZATION Under the general supervision of Home Medical Equipment Office Supervisor.

Working relations with all ancillary department and co-workers.

The ability to function responsibly in a minimally supervised work situation. Must be a self-starter and self-directed. Proven decision-making skills are required. SPECIFIC DUTIES

  1. Supports the Mission, Vision and Values of Munson Healthcare

  2. Embraces and supports the Performance Improvement philosophy of Munson Healthcare.

  3. Promotes personal and patient safety.

  4. Uses effective customer service/interpersonal skills at all times.

  5. Able to establish priorities and meet tight deadlines with strong problem solving ability

  6. Exercises a high degree of control over confidential medical information.

  7. Completes accurate, compliant, and well documented third party cost reports.

  8. Analyzes financial and statistical data used in the reimbursement reports to determine accuracy, consistency from year to year, and effects upon institution's reimbursement or final settlements. • Review denials and determine cause. • Provide internal audits related to reimbursement/compliance • Recommend new fee schedules/contracts or processes • Identify compliance with billing processes
  9. Verifies and analyzes price tables for accuracy
  10. Maintain up-to-date knowledge of principles and technical methods of reimbursement with Home Medical Equipment payers
  11. Provides up-to-date reimbursement rate information to the Accounting Department to enhance the monthly contractual allowance calculation. Periodically reviews the monthly contractual allowance calculation.
  12. Participates in Audits and suggests areas where formal appeals to third-party and governmental agencies are warranted

  13. Responsible to keep current on billing requirements from third parties such as, Blue Cross/Blue Shield, Medicare, Medicaid, and all other health insurance carriers.

  14. Interprets and initiates problem solving, prioritizes work activity.

  15. Keeps educational information, manuals and guides at team level updated and current.

  16. Works various reports.

  17. Meets productivity and quality standards.

  18. All other duties as assigned.

Company Info

Company Name
Munson Medical Center
Zip/Post Code
49696
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