OT DME Precertification Coordinator

Job Details

Description

It’s the people that make the difference. Are you ready to make your impact?

Midwest Orthopedics at Rush is nationally recognized as a leader in comprehensive orthopedic services. The Orthopedic Program at Rush University Medical Center is ranked Top 10 in Orthopedics by U.S. News and World Report. Founded in 2003, MOR is comprised of internationally-renowned Orthopedic and Spine surgeons who pioneer the latest advances in technology and surgical techniques to improve the lives and activity levels of patients around the world. MOR doctors are the official team physicians for the Chicago White Sox, Chicago Bulls, Chicago Fire Soccer Club and DePaul University Athletics.

Ready to join? We are looking for a full-time OT DME Precertification Coordinator, who would report to our Director of Hand Therapy. Verifies insurance coverage, computes patients' benefits, and compiles itemized hospital bills by performing the following duties. The position will be based out of the Orthopedic Building in Chicago with the potential for a remote schedule once fully trained and proficient in the role. Candidate will need to have the ability to travel in-office as needed for meetings.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Responsible for obtaining prior approval/precertification from patient’s insurance company for OT/Custom DME.
• Verifies patient insurance information.
• Obtains benefit information and/or prior approval for services via telephone, facsimile, or internet.
• Verifies in-network and out-of-network coverage levels for DME. If an out-of-network service or non-covered item, follows out of network protocols and “No Surprises Billing Act.” Refers patients with out of network coverage to Financial Coordinator to discuss payment options.
• Coordinates all documentation required for precertification of services including, but not limited to the medical record, pre-operative reports, and Letters of Medical necessity. Is familiar with the general surgical procedures performed by each physician.
• Requests assistance from manager or physician office if additional clinical information is required. Requests for necessary documentation from each physician.
• Notifies physician office and/or patient when services are not approved. Knows process and protocols for appealing precertification decisions.
• Keeps records of phone calls. Notes, name of contact, phone number and any required reference numbers.
• Contacts insurance companies and third-party administrators in a timely fashion. Can organize and prioritize workflow based on the needs of each physician office.
• Works well with and responds promptly to requests by therapists, physicians, physicians’ secretaries, and other staff.
• Always utilizes professional telephone conduct.
• Understands that the mission of Midwest Orthopaedics at RUSH is to meet patient needs and provide the patient with highest level of medical care.
• Answers patients' questions regarding statements and insurance coverage.
• Must be able to follow and submit additional clinical information when requested or follow appeals process related to denials.
• Until full caseload is established, may assist with other administrative tasks as requested by Director of Hand Therapy and/or Director of Rehab.
• May assist with therapy department with beginning of the year re-verifications, time permitting.
• Adapts to change in a positive and professional manner.
• Other duties may be assigned.
  
  

Education And/or Experience

• High school diploma or general education degree (GED)
• Minimum of one year's work experience, preferably in a medical office setting
• Experience working with medical insurance companies is beneficial.
• Demonstrated ability to communicate clearly & concisely, both verbally & in writing, with peers, supervisors, payers, physicians, physicians' practice, patients and other office departments
• Ability to work independently and as part of a team.
• Proficient in using medical records systems.
• Ability to multitask.
  
  

What’s in it for you? MOR offers their employees a comprehensive compensation and benefits package.

Pay Range: $21.00 - $24.00 per hour. Compensation at MOR is determined by many factors, which may include but are not limited to, job-related skills and level of experience, education, certifications, geographic location, market data and internal equity. Base pay is only a portion of the total rewards package.

• Medical, Dental and Vision Insurance.
• Paid Time Off and Paid Holidays.
• Company-paid life and long-term disability insurance.
• Voluntary life, AD&D, and short-term disability insurance.
• Critical Illness and Accident Insurance.
• 401(k) Savings Plan.
• 401(k) Employer Contribution.
• Pet Insurance.
• Commuter Benefits.
• Employee Assistance Program (EAP).
• Tax-Advantaged Accounts (FSA, HSA, Dependent Care FSA).
• HSA Employer Contribution (when enrolled in a HDHP).
• Tuition Reimbursement.
• Excellent working relationship with prestigious group of physicians in Orthopedics in the US and #1 in Illinois and Indiana.
  
  

Our employees make the difference in our patients’ lives, and we value their contributions. Midwest Orthopaedics at Rush offers a comprehensive compensation and benefits package and an opportunity to grow and develop your career with an industry leader. Come see what we’re all about. Equal Employer Opportunity.