Durable Medical Equipment Clerk

Description

Under the direct supervision of the CCSC Manager, the Durable Medical Equipment (DME) Clerk's responsibilities include receiving, reviewing, & authorizing referrals for DME, Orthotics, Prosthesis & Mobility devices from medical center professionals. Responsibilities also include authorizing & ordering equipment from outside vendors, computing bills, analyzing & processing DME forms. The position also involves medical record review to ascertain appropriateness of ordered equipment, investigation & tracking of pertinent patient information, & performing related departmental duties according to established procedures.

Essential Functions:

Receives, authorizes, & processes orders from Kaiser medical staff.

• Verifies membership eligibility.


• Enters ICD-9 & HCPC codes per CMN regulations.


• Reviews medical records.


• Consults w/ physicians, nurses, therapists, & Health Plan.


• Answers Service Center phone line.


• Serves as liaison between. (Physician, medical staff, patients, patient's family & suppliers).


• Investigates & tracks pertinent information by record keeping, computer abstraction.


• Continuous follow up for renewal, denial, & purchase of equipment.


• Other duties as assigned.

Secondary Functions:

• Answer all incoming DME phone calls from members, vendors, nurses, physicians and discharge planners and community agencies for the Service Areas.


• Reviews all incoming prescription, checks for appropriate benefits using the Foundation System, prioritizes workflow and processes the prescription by either ordering the equipment or sending for clinical review.


• Confers with RN over any clinical issues in which a problem arises.


• Orders equipment/supplies using the DOTS system.


• Participate in quality assurance activities of the department and may assist in orientation of new staff.

Grade 05

Qualifications

Basic Qualifications:

• Requires minimum of one-year of customer service experience.


• High School diploma or equivalent.


• Must have history of excellent customer service skills exhibited by courtesy, cooperative spirit & tact when interacting w/ patients, families, & staff.


• Must have M.S. Word & Excel, Health Plan knowledge & Medicare knowledge of DME guideline.


• Requires typing of 40WPM


• Previous knowledge of medical terminology.


• ICD-9 & DME strongly preferred

Preferred Qualifications:

• Basic computer skills


• Customer service skills.


• Foundations system experience preferred, basic knowledge of Commercial, Medicare Cost, KPSA coverage preferred.


• Lotus Notes experience, DME ordering and tracking system experience preferred.


• Must be competent in DOTS within 6 months of hire.


• Minimum one year clerical experience required within last two years.


• Good reading and writing skills required. Prior data entry experience and word processing skills preferred.


• Must be able to communicate calmly in high stress situations.


• Demonstrated ability to effectively communicate and negotiate resolution of problems with providers, outside vendors and levels of management.


• Working knowledge of CIPS/Health Connect preferred. Skills Testing: Typing 40 WPM, Medical Terminology, and Basic Computer Literacy (BCL)