HME Intake Specialist (reports to supervisor)

DCH Health Care Authority•Tuscaloosa, AL

7d•Onsite

About The Position

The HME Intake Specialist obtains and reviews accurate information for home medical equipment (HME) referrals and orders, applying payer guidelines and criteria from the Medicare Supplier Manual, Local Coverage Determinations, related articles, and the Program Integrity Manual. The role ensures that coverage and billing requirements are met, determines when an Advance Beneficiary Determination or Advance Beneficiary Notice is needed, and discusses payment criteria with patients before equipment delivery. The specialist manages referrals, physician orders, Certificates of Medical Necessity, insurance verification, and medical documentation. The position also involves patient contact and education; equipment delivery, pickup, testing, cleaning, maintenance, and repair coordination; billing and payment collection; and collaboration with colleagues to coordinate patient equipment needs and improve referral and billing processes. The role rotates in departmental on-call coverage and requires physical presence onsite.

Requirements

High school diploma or GED.
Ability to type 20 words per minute.
Proficiency with Microsoft Office, including Excel and Word.
Obtain BLS Healthcare Provider CPR within the first 90 days of employment.
Excellent customer service and organizational skills.
Ability to work independently, prioritize tasks, and perform in a fast-paced environment.
Ability to read, write legibly, speak, and comprehend English.
Ability to perform the duties with or without reasonable accommodation.
Normal or corrected-to-normal hearing and vision.
Ability to perform light work: exert up to 20 pounds of force occasionally, up to 10 pounds frequently, and a negligible amount constantly.
Ability to perform physical activities including walking, talking, hearing, bending, twisting, stooping, lifting, kneeling, standing, sitting, crouching, grasping, pushing, pulling, and repetitive hand motions.
Physical presence onsite is essential.

Nice To Haves

CPAP and/or respiratory experience.

Responsibilities

Meet with patients to review their home medical equipment needs.
Review and monitor home medical equipment referrals, applying applicable coverage guidelines.
Ensure required medical documentation is available in the patient record before billing, covers the relevant time period, and is properly signed, dated, and authenticated.
Initiate attestation paperwork when documentation is not signed and dated according to the Program Integrity Manual.
Enter patient information into the HME software.
Verify patients’ insurance coverage for requested items, complete insurance verification forms, interpret coverage, calculate patient responsibility, and discuss payment criteria with patients before delivery.
Monitor physician orders for timely completion and proper signatures and dates.
Contact patients at specified intervals to assess use of supplies and equipment, offer appropriate suggestions, and document contacts.
Maintain equipment guarantees and warranties, and update the Director weekly on equipment and supply inventory needs.
Process claims, generate bills, and ensure monies owed are collected in accordance with the DCH HME Cash Handling Policy.
Deliver and pick up equipment and supplies at patients’ homes, DCH Home Medical Equipment, or the hospital.
Educate patients on proper equipment use and maintenance, perform functional tests before setup and delivery, and provide troubleshooting guidance.
Clean equipment and ensure maintenance is completed and recorded in the HME software.
Coordinate equipment repairs with manufacturers, including obtaining return authorizations and packaging equipment.
Respond to patient calls and route them according to urgency.
Generate and track Certificates of Medical Necessity and ensure timely physician signatures as required.
Initiate and complete Advance Beneficiary Notices when appropriate.
Update the manager about referral and billing problems and process-improvement opportunities.
Coordinate deliveries to ensure patients receive equipment as promised.
Work collaboratively with the team on calls, walk-ins, and patient equipment needs.
Rotate in departmental on-call coverage.
Meet applicable DCH performance, patient and employee satisfaction, financial, compliance, behavioral, and safety standards; follow DCH policies and procedures.
Use electronic mail, time-and-attendance software, learning-management software, and the intranet.
Perform other duties as assigned.