Durable Medical Equipment Consultant- Remote

Gainwell Technologies LLC

3d•$64,500 - $92,200•Remote

About The Position

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. SummaryThe Durable Medical Equipment Consultant will review Medicaid Prior Authorizations based on medical necessity in accordance with State policy guidelines, provide guidance and support for Medicaid Providers when appropriate, and act as a clinical SME (or liaison) for internal Gainwell entities. Note: This is not a patient facing position.

Requirements

Current Occupational Therapy, Physical Therapy or RN license in the state of WI (or license from another state and ability to obtain WI license prior to position start date).
Extensive experience in the DME field, including both the provision, delivery and appropriate pricing and coding of durable medical equipment.
Knowledge of and/or experience working with the Wisconsin Medicaid program (or other state’s Medicaid programs)
Excellent interpersonal, oral, and written communication skills.
Ability to meet deadlines and manage priorities with minimal direct supervision.
Experience working with various partners or team members toward shared goals.
Ability to communicate effectively and interpret policies and procedures.

Responsibilities

Adjudicating Durable Medical Equipment and prior authorizations based on medical necessity and eligibility, in accordance with State policy guidelines and accepted dental practices.
Reviewing and evaluating prior authorization submissions utilizing multiple computer systems, and when appropriate seeking additional information or clarification from requesting Provider
Entering prior authorization outcome into the Medicaid Management Information System (MMIS) for processing.
Participation in monthly meetings which include Gainwell leadership, operational staff support, clinical peers and State stakeholders.
Providing assistance and education to the provider community related to specific prior authorization submissions, when applicable.
Offering analysis and recommendations to Gainwell and State leadership on methods and potential process improvements related to the administration and application of the dental program.
Review communications to providers and members on new/revised policies.