Review of accounts/orders to ensure all proper documents and guidelines are followed to include, but not limited to; active policy, DME covered benefits, proper ICD 10, valid med docs, proper HCPC codes
- Must be familiar with Insurance payors (Medicare, Medicaid, UHC, BCBS, Presbyterian, Humana, Aetna Tricare etc) to include:
- Understanding of DME qualifications for each payor listed and for multiple types of DME. Oxygen, Wheelchairs, Front Wheeled walkers, 4 wheel walkers,
Hospital Beds etc.
- Medicare knowledge of Oxygen to include: qualifying Sat's, Nocturnal vs 24/7, Same/Similar, O2 rental cap, O2 HCPC codes
- Ability to identify cap rental items vs Purchase Items and ensure proper coding of the product dispensed
- Understanding of Insurance eligibility and benefits. Knowledge of Deductible, copay and coinsurance and COB
- Familiar with use of Medicare CGS Portal, verifying same/similar, and LCD's
- Navigating provider portals
- Familiar with intake process for patient account to ensure completion
- Able to identify valid RX and interpret clinical notes for medical need
- Familiar with ICD 10 coding to identify qualifying Diagnosis as required for certain DME items
- Brightree Knowledge - able to navigate thru portal to locate, eligibility, med docs, notes
- Able to identify and familiar with required documents to bill specific payors (DT, POC, ABN Home assessment etc)
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