Clinical Services Lead

Previous Durable Medical Equipment (DME) order processing experience is required. 

Basic Function:

Under the direction of the Customer Service Manager, this position oversees all service functions related to durable medical equipment orders for PAP, Oxygen and Enteral therapies. This position is integrated into all daily aspects of the clinical services team and is responsible for ensuring the department is adhering to process and productivity goals.

Requirements:

• Minimum of three years’ experience in DME in customer service.
• Proven performance record in DME customer service.
• Strong knowledge of federal, state and accrediting body regulations.
• Excellent human relation skills with the ability to mentor/train/coach various levels of staff with varying backgrounds.
• Demonstrates ability to work successfully with internal and external contacts.
• Strong collaborative and demonstration skills in facilitating teamwork.
• Excellent written and oral communication; organizations skills required.
• Demonstrates ability to work independently.
• Clear understanding of Prism Health Care Services, Inc. departments and the different Prism Health Care Services, Inc. revenue cycle positions and responsibilities.
• Demonstrate excellent oral and written communication, problem solving, investigational and analytical skills along with excellent listening and interpersonal skills.

Principle Responsibilities:

• Facilitate training and mentoring for all new and existing clinical service department employees.
• Facilitates and provides feedback to Supervisor on barriers, issues and risks to the referral management process.
• Communicate daily metric reports developed by Revenue Cycle Leadership to analyze productivity with the goal of improving company metrics.
• Maintain visibility to “Urgent Orders” to ensure accurate and timely processing.
• Facilitate training to identify additional services to improve patient outcome.
• Facilitate clinical services team to provide administrative support for Respiratory Therapists and clinical professionals to triage inbound communication.
• Promote company program and services to assigned referral source.
• Supports the mission, vision and strategic plan of the organization.
• Responds to customer requests courteously and with respect.
• Approaches customers and inquiries in a manner which represents ownership.
• Works with Quality Assurance to ensure details of referrals are complete and accurate prior to delivery and patient education.
• Build and maintain positive relationships with referral sources to include education on medical equipment qualification and policy changes.
• Build and maintain positive relationships with internal company leads to include education on medical equipment qualification and policy changes.
• Assist with administrative support for PAP compliance.
• Refers troubleshooting calls to clinical departments, if needed.
• Verifies completion of patient records to include all supporting documentation.
• Resolves customer complaints by investigating problems and making recommendations to Revenue Cycle Leadership.
• Reports any patient or referral related problems to Supervisor immediately.
• Communicate information to respiratory and distribution departments, as needed.
• Maintain current knowledge of Medicare, Illinois Public Aid and insurance industry policies and guidelines.
• Attend in-service training when required.
• Responds to customer requests, voicemails and emails as established by company policy.
• Maintains a clear professional style of oral and written communication.
• Manages resources to maximize efficiency and productivity of the Vitality Program.
• Contributes to team effort by accomplishing related metrics as needed.
• Meets monthly and quarterly referral metrics.
• Interacts in strict adherence to HIPPA compliance regulations and related company policies.
• Strives to attain monthly referral metrics by supporting sales team platform to promote the organization.
• Implement and maintain completion of training to comply with ACHC standards.
• Performs other duties as assigned.