What are the responsibilities and job description for the DME Coordinator position at Hudson Regional Hospital?
Responsibilities:
Manage DVT program surgery centers and hospitals to help reduce risk of deep venous thrombosis or pulmonary embolism during ambulatory surgeries.
Manage billing line of business for both surgery centers and outside clients. This includes identifying billable cases, charge entry, follow up, payment posting, denial resolution and month end reporting.
Responsible for staying current with and educating staff on all NYS Workers Compensation and No Fault rules, regulations and guidelines for Ambulatory Surgery Centers, durable medical equipment, DVT program and transportation lines of business.
Responsible for new orders for medical devices and equipment and ensure all documentation is complete and compliance standards are met.
Complete all necessary steps required for items to be delivered to patients while ensuring reimbursement and authorization guidelines are fulfilled.
Convert text diagnoses into ICD-10 codes and ensure final diagnosis is documented properly.
Verify insurance eligibility for coverage and medical necessity guidelines.
Obtain prior authorizations and determinations of medical review from insurance carriers.
Research and review National Correct Coding Initiative edits, utilization threshold and coverage guidelines.
Manage insurance claims, identifying and resolving denials and coding errors, and refiling claims or engaging all levels of the appeals process in accordance with government and payer regulations.
Prepare responses to documentation reviews and audit requests, including CMS, RAC, CERT, and private payer coding, promptly and accurately, within strict time limits. Inform management of compliance issues or coding discrepancies.
