Durable Medical Equipment Clerk Job Listing at Kaiser Permanente in La Mesa, CA (Job ID 4497849-2024-08-19)

Description

Job Summary:

Under the supervision of the DME Manager, the Durable Medical Equipment (DME) Clerks responsibilities include receiving, reviewing and authorizing the referrals for DME and Prosthetic & Orthotic (P&O) orders. Data input for electronic ordering of DME and P&O items from outside vendors. Analyze and process DME forms and medical record review to ascertain appropriateness of ordered DME or P&O items. Investigates and tracks pertinent patient information. Performs related departmental duties according to established DME policies and procedures. DME Clerk must have demonstrated a history of excellent service skills exhibited by courtesy, cooperative spirit and tact when interacting with patients, families, and staff.

• A. Receives, reviews and authorizes the referrals for DME and P&O orders. 1.Receives, reviews and processes referrals for DME and P&O orders. 2. Reviews and completes the Notice of Non-Coverage (NONC) Process 3. Interprets Benefits for each patient as it applies to DME criteria 4. Maintains an understanding of Regulatory Requirements 5.Investigates and tracks pertinent patient information.

• B. Authorize and orders equipment from outside vendors, analyzing and processing DME forms and reviews medical review to ascertain appropriateness of ordered equipment or prosthesis. 1. Understands the DME Referral (Orders or Prescriptions) and the administration of the Benefit according to the guidelines appropriate to the DME formulary or Evidence of Coverage (EOC). 2. Maintains a working knowledge of all benefit administration and formularies tools. 3. Maintains a daily coordination of Claims/Invoice Management. 4.Proficient management of the Kaiser ordering and tracking systems.

• C. Performs excellent service skills: and other related departmental duties according to established policies and procedures in the area of: 1. Performs consistent professional Customer Service regarding DME information and services to members, providers, ancillary support, vendors, etc. 2. Duties may also include problem resolution, customer follow-up and appropriate escalation to administration as required. 3. Participate in DME Projects and Workgroups as requested.

• D.Performs other related departmental duties according to established policies and procedures in the area of: 1.Independent use of information systems. 2. General Administrative Responsibilities: Phone activity Data entry Faxing Mailings Upholds Kaiser Permanentes Policies and Procedures, Principles of Responsibilities and applicable state, federal and local laws.

• Previous 1-year clerical experience in an acute care/health care setting, DME or Home Health.

• Formal medical terminology training with certificate required or ability to pass standard test

• High School Diploma;

• Medical Terminology

• N/A

• 40 wpm

• HMO Experience;

• Knowledge of DME guidelines, care management and regulatory requirements.

• Knowledge of Regulatory Regulations (CMS, Medi-Cal, TJC, NCQA, DMHC)

• Excellent verbal and written skills. Good interpersonal relationship building skills.

Notes:

• this is based on rotation and daily operations of the department