DME CLERK Grade 5 (39) Job in Walnut Creek, California Us
Under the direct supervision of the CCSC Manager, the Durable Medical Equipment (DME) Clerk's responsibilities include receiving, reviewing, authorizing referrals for DME, Orthotics, Prosthesis Mobility devices from medical center professionals. Responsibilities also include authorizing ordering equipment from outside vendors, computing bills, analyzing processing DME forms. The position also involves medical record review to ascertain appropriateness of ordered equipment, investigation tracking of pertinent patient information, performing related departmental duties according to established procedures.
Essential Functions:
- Receives, authorizes, processes orders from Kaiser medical staff
- Verifies membership eligibility
- Enters ICD-9 HCPC codes per CMN regulations
- Reviews medical records
- Consults w/ physicians, nurses, therapists, Health Plan
- Answers Service Center phone line
- Serves as liaison between. (Physician, medical staff, patients, patient's family suppliers)
- Investigates tracks pertinent information by record keeping, computer abstraction
- Continuous follow up for renewal, denial, purchase of equipment
- Other duties as assigned
Secondary Functions:
- Answer all incoming DME phone calls from members, vendors, nurses, physicians and
discharge planners and community agencies for the Service Areas.
- Reviews all incoming prescription, checks for appropriate benefits using the Foundation
System, prioritizes workflow and processes the prescription by either ordering the equipment
or sending for clinical review.
- Confers with RN over any clinical issues in which a problem arises.
- Orders equipment/supplies using the DOTS system.
- Participate in quality assurance activities of the department and may assist in orientation of new staff
Qualifications:
Basic Qualifications:
- Requires minimum of one-year of customer service experience
- High School diploma or equivalent
- Must have history of excellent customer service skills exhibited by courtesy, cooperative spirit tact when interacting w/ patients, families, staff
- Must have M.S. Word Excel, Health Plan knowledge Medicare knowledge of DME guidelines
- Requires typing of 40 WPM
- Previous knowledge of medical terminology
- ICD-9 DME strongly preferred
Preferred Qualifications:
- Basic computer skills required.
- Customer service skills required.
- Demonstrated good attendance record required.
- Foundations system experience preferred, basic knowledge of Commercial, Medicare Cost, KPSA coverage preferred.
- Lotus Notes experience, DME ordering and tracking system experience preferred.
- Must be competent in DOTS within 6 months of hire.
- Minimum one year clerical experience required within last two years.
- Good reading and writing skills required. Prior data entry experience and word processing
skills preferred.
- Must be able to communicate calmly in high stress situations.
-Demonstrated ability to effectively communicate and negotiate resolution of problems with
providers, outside vendors and levels of management.
- Working knowledge of CIPS/Health Connect preferred.
Skills Testing: Typing 40wpm, Medical Terminology and Basic Comuter Literacy (BCL)
++NOTE: Must be able to pass basic computer literacy test. Current medical terminology certificate (within the last 3 years) or medical terminology testing required++
Schedule Details: Short-hour, Regular; 16 hrs/wk; Day Shift; 8:30AM To 5:00PM. (NOTE: Every Saturday and Every other Friday and Sunday. May include some holiday work. Holiday work to be assigned per union contract guidelines )