Durable Medical Equipment Benefit Lead Coordinator

This position is accountable for extending the administrative capacity of the DME Supervisor by assuming responsibility for day-to-day functions such as schedules, staffing, work-flow monitoring and assignments, training, metrics monitoring and measuring, etc. This work will be done in addition to providing the full-line of products and services to Kaiser Permanente Health Plan members as covered by the Durable Medical Equipment (DME) benefit to include: prosthetics, orthotics, DME equipment and supplies, enterals/nutritionals and oxygen. To act as a resource for physicians, clinicians and health plan members throughout the region. To ensure orders are in compliance with Kaiser Permanente, Medicaid and Medicare guidelines, billing instructions and limitations, and benefit eligibility. This position works under indirect supervision of the DME Supervisor in the Durable Medical Equipment department in support of the mission of the Northwest Region and through the commitment of organization funds in administering the DME Benefit.

• Human Resources Management: Scheduling staffing for all employees within the department; approve time off requests and arrange for appropriate staffing levels. Orient, train, counsel and evaluate employees in accordance with department performance standards and agreements. Prioritize work flow and monitor employee progress, performance, productivity and performance. Identify and effectively resolve work group process issues; chair/facilitate/represent DME at assigned committee meetings. Work with the manager to identify and implement work process improvements and to ensure operational compliance to regulatory requirements.


• Manage costs through effective utilization review of rental equipment. Actively manage the data base; review the expired/expiring patient authorizations; determine appropriate action and associated timelines, assign responsibility, audit follow-up, communicate with Vendor. Determine on-going need of rental equipment/supplies/oxygen based on clinical need, diagnosis and prognosis, regulatory guidelines. Work with appropriate clinician/physician to proactively recommend cost-effective changes in service delivery e.g. rental to purchase, discontinuation of service, step-down of product category, etc.


• Resource Management: Proactively audit DME systems and data to look for unusual expense, utilization patterns, changes in trending, or any flags that warrant investigation. Identify cost saving/cost avoidance opportunities. Perform root cause analysis and make recommendations for resolution. Analyze performance data to valid operations assumptions or identify shifts in practice that drive cost or regulatory compliance issues. Develop, review, update and maintain all policies and procedure relating to DME.


• Project Management: Serve as the department liaison for NW region initiatives. Represent DME operations and regulatory issues, act as a member of the regional team to design, develop and implement new systems, communicate to DME staff, interact with multiple people and departments throughout the organization.


• Review, validate and process all eligible physician/clinician referral requests; review referral for appropriateness and completeness, review health record to determine medical need and compliance to Medicare guidelines, contact vendor, coordinate delivery and pick-up of equipment with vendor/clinician/patient. Maintain compliance to regulatory standards for response times. Ensure member eligibility for DME services: both benefit and current Medicare guidelines.


• Ensure customer satisfaction by providing fast, reliable, courteous, auditable, appropriate service to our customers. Act as a liaison for DME services to all customers in the supply chain, both internal and external e.g. Care Coordinators, Discharge Planners, Home Health, Clinicians, Physical Therapy, Respiratory Therapy, Vendors, Claims, Purchasing/Contracting, Pharmacy, Members, etc. to ensure customer satisfaction. Problem-solve, serve as a resource; provide information on products, services, and processes. Perform other duties as requested.

Qualifications:

• Minimum one (1) year of experience with PCs/on-line computer systems.


• Minimum one (1) year of experience working as a DME Coordinator.

• Associate degree in healthcare related field OR two (2) years of experience in a directly related field.
• High School Diploma or General Education Development (GED) required.

• N/A

• Demonstrated experience working independently in a multi-task environment.
• Medical terminology.
• Basic understanding of Medicare regulations, particularly as they pertain to the provision of Part B benefits.
• Basic understanding of Medicaid regulations for Oregon and Washington state.
• DME equipment/supply knowledge.
• Demonstrates customer-focused service skills.
• Excellent communication skills both oral and written.
• Keyboard proficient.

• Minimum three (3) years of experience in the provision of DME to patients either commercially or in another healthcare organization.
• Minimum three (3) years of experience working in customer service.
• Minimum two (2) years of experience with on-line systems.
• Minimum two (2) years of experience working as a Lead or Supervisor.
• Knowledge of Kaiser Permanente HR policies and procedures.
• Knowledge of the Kaiser Permanente systems and processes.
• Knowledge of HMO environment.
• HCPC coding knowledge
• Working knowledge of health plan benefits and policies.