Durable Medical Equipment (DME) Operations Specialist

Logan Health Medical Center•Kalispell, MT

12d

About The Position

This position is the primary resource for durable medical equipment (DME) compliance, billing rules and regulations for Logan Health Medical Equipment (LHME). Our Mission : Quality, compassionate care for all. Our Vision : Reimagine health care through connection, service and innovation. Our Core Values : Be Kind | Trust and Be Trusted | Work Together | Strive for Excellence.

Requirements

Minimum of one (1) of the following required:
Minimum of two (2) years’ DME experience.
Minimum of two (2) years’ healthcare billing experience.
Knowledge of rules and regulations pertaining to Medicare, Medicaid, and other contracted services required.
Excellent organizational skills, detail-oriented, a self-starter, possess critical thinking skills and be able to set priorities and function as part of a team as well as independently.
Commitment to working in a team environment and maintaining confidentiality as needed.
Excellent verbal and written communication skills including the ability to communicate effectively with various audiences.
Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.
Possess and maintain computer skills to include working knowledge of Microsoft Office Suite and ability to learn other software as needed.

Nice To Haves

Possess knowledge and understanding with rules and regulations regarding coverage of durable medical equipment and respiratory claims for Medicare/Medicaid and other Third party payers preferred.

Responsibilities

Audits patient account documentation and provider related clinical documentation for insurance billing per department protocol.
Assists billing office with appeals, re-determinations and other billing issues related to patient accounts.
Monitors reimbursements and allowables related to insurance claims to maximize reimbursement.
Monitors Medicare coverage criteria and billing regulations to ensure LHME is compliant with Local Coverage Determinations (LCD) per department protocol.
Acts as a resource for documentation requirements for appropriate stakeholders.
Performs a variety of administrative, accounting, and billing tasks in order to complete the business cycle.
Provides excellent customer service.
Timely and accurately responds to all audit requests per department procedures.
In collaboration with assigned leadership, reviews and provides feedback and updates to policies and procedures.
In collaboration with assigned leadership establishes controls for an effective DME compliance program and monitors DME compliance training for staff.
Responds to reported and/or detected DME compliance concerns and advises assigned leadership per department protocol.
Develops and monitors LHME’s DME compliance program in collaboration with assigned leadership, to ensure that LHME is meeting HQAA standards of care.
Stays abreast of DME and Respiratory services and changes.
The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job. Not all of the duties may be assigned to a position.
Maintains regular and consistent attendance as scheduled by department leadership.