Website Express Scripts
The Durable Medical Equipment (DME) Case Administrator will be responsible for initiating and maintaining workflow activities for the DME Health plan product by receiving and placing inbound/outbound communications between eviCore Healthcare stakeholders and External Customers including but not limited to hospitals, physicians, and suppliers. The DME Case Administrator will receive incoming data for the Prior Authorization of Durable Medical Equipment (DME), enter the received data into a platform utilizing defined internal department processes and company protocols. The DME Case Administrator will be responsible for continual research/reading becoming well versed in our varied customers’ current contract language and work process flows for multiple health plans across multiple states. The DME Case Administrator will work closely with nursing staff and the Medical Director in both the DME Prior Authorization phase as well as through the possible appeals and redeterminations phase to ensure compliance with Commercial, Medicare and State guidelines as well as identify and report any trends that become apparent.
- The DME Case Administrator will house the ability to research and resolve issues pertaining to the Prior Authorization process of Durable Medical Equipment and day-to-day operational concerns using defined internal department processes and company protocols.
- The qualified candidate will house the ability to provide excellent customer service by handling confidential and sensitive information with discretion during communication with external and internal contacts ensuring the development of strong relationships with these stakeholders while clearly representing business needs as well as business determinations.
- The DME Case Administrator will possess well developed critical thinking skills with the ability to multi task and effectively communicate, in oral as well as written form, paying attention to detail including spelling and grammar while effectively transferring data, interactions and thoughts in a timely and concise manner with all stakeholders.
- Experience with various insurance products including Managed Care, Medicare Advantage, Medicare and Medicaid desired
- Associates or Bachelor’s degree preferred
- Experience with the healthcare community,ICD-9 or ICD-10 Coding, Claims Processing, knowledge of HCPCS Codes as well as familiarity with Durable Medical
- Equipment preferred
Qualification & Experience:
- Certification in ICD 9, ICD 10 coding preferred
- High School graduate with diploma or GED
- 2+ years of experience in a healthcare focused industry or a customer service focused industry required
Company: Express Scripts
Vacancy Type: Full Time
Job Location: Melbourne, FL, US
Application Deadline: N/A