MIR Specialist - West Region

National Seating & Mobility•West Carson, CA

51d•Remote

About The Position

Coordinates with the Funding Manager, Funding Supervisor, Branch Manager, Rehabilitation Technology Supplier (RTS), and other office support personnel to ensure all operational procedures are completed in accordance with company policy and within expected time frames. Responsible for correcting and reworking any order that is unable to be billed or has resulted in a claim denial due to missing or incorrect information. This can include Coding & Pricing, gathering information and documents pertinent to the funding package, ensuring that all documentation is in place, submission to the funding sources and collecting payer decisions including authorizations, denials, and deferrals.

Requirements

Has minimum of 3 years of experience related to Durable Medical Equipment and/or Complex Rehab Technology required, preferred experience in all aspects of a Funding Specialist’s position including how to process both Repairs and Non-Repairs.
Has extensive knowledge of the process and insurance guidelines to secure funding for Durable Medical Equipment and/or Complex Rehab Technology including comprehensive knowledge of insurance verification for DME.
Proficient in Microsoft Excel, Word, and Outlook.
Strong ability to problem solve, knowledge of NSM P&P and ability to interpret and follow payer guidelines and all Policies and Procedures.

Responsibilities

Responsible for problem-solving, correcting, and reworking any order that is unable to be billed or has resulted in a claim denial due to missing or incorrect information.
Ensures the accuracy of and completes updates to all required coding, modifiers and pricing.
Verifies client benefits and coverage and communicates benefit information to client.
Gathers and reviews documentation for payer, including but not limited to: proper prescriptions, Letters of Medical Necessity (LMN), RTS evaluation information, price lists, forms (AOB, ABN, rent or purchase letter).
Communicates regularly with Physicians, Therapists, RTSs, and Clients in an effort to secure documentation as required by payer.
Communicates changes and escalations in the process and collects needed information from branch personnel, Referral sources, Physicians, Therapists, RTSs, and Clients.
Investigates and updates any payer requirements.
Maintains communication with client throughout the process when applicable, including notifying them of financial responsibility.
Coordinates with branch staff to secure pick up and redelivery documentation as required.
When appropriate, discusses and secures approvals to write off or adjust balances.
Communicate with Billing and Collection team to ensure that timely filing deadlines are met and/or to resolve any clarification on MIRs.
Properly noting and closing MIRs with a complete and thorough response through the Funding Portal and Mobility Advisor.
Performs any related job duties assigned by the MIR Manager. Carries out all position expectations in a professional manner and with minimal supervision.
Responsible to complete all continuing education requirements to include assigned NSM University courses.
Must maintain regular and predictable attendance.