Durable Medical Equipment; DME Advocate

Overview

Durable Medical Equipment (DME) Advocate

Remote position for South Carolina Residents Only!

Position Summary:

The DME Advocate is a non-clinical position that assists the clinical staff in supporting members with acute and chronic clinical conditions for the Medically Complex Children’s Waiver (“MCCW”) program in South Carolina.

Job Requirements and

Competencies:

DME Advocate will have extensive knowledge of durable medical equipment. Strong Communication Skills both verbal and written. Exceptional customer service skills and capable of working with diverse cultures and personalities. Commitment to create an extraordinary experience with each participant’s family.

Essential Duties and Responsibilities:

• Ensures and maintains the confidentiality of all Personal Health Information collected
• Accurately narrating gathered information in participants chart through Phoenix (SCDHHS software)
• Manage the access to PHI in accordance with federal and state requirements for HIPAA, HITEC
• Work as a liaison between other employees, providers, and participant families
• Accurately log DME information for tracking purposes on master spreadsheet
• Communicate with all involved parties to ensure information is up to date
• Review/research charts for DME information and provider information
• Prepares communication to Physicians and Providers for requested DME
• Consistently follows up with DME providers to ensure all documents have been received and all information is in process for streamline processing.
• Works closely with all Care Coordinators and Care Advocates to provide the best possible service to participants
• Accurately prepares referral documentation to providers for DME orders
• Gathers information for denials of DME to consist of denials from Kepro, private insurance, Provider cost sheet, CMN/LMN, and any other supporting documentation
• Monitors participants eligibility status
• Provide support to participant families with resource information for non-covered DME, which will require research and communications
• Coordinate with outside referral sources for DME to assist in participant DME needs
• Receives information regarding participant via facsimile, telephone, email, and text message
• Quality Assurance

Supervisory Responsibilities: None

Competencies:

• Strong organizational and interpersonal skills
• Excellent written and verbal communication skills
• Detail oriented
• Ability to multi-task and work independently
• Strong competency in Microsoft Office products including Word and Excel

Qualifications:

Education and Experience:

• A high school diploma or equivalent is required.
• Knowledge of medical terminology is required.
• Previous DME experience is preferred.
• A minimum of two years’ work experience as a MCCW Care Advocate or previous DME knowledge preferred.
• Proficiency in data entry skills
• Strong customer service/telephone skills

Environmental Factors/Physical Demands:

Work is performed in an office and occasional travel/driving will be necessary. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to extensive sitting, repetitive motion such as typing, data entry and vision to monitor.

May be subject to bending, reaching, kneeling, stooping, and lifting up to thirty (30) pounds.

Other Responsibilities:

This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Duties, responsibilities, and activities may change at any time with or without notice.

• Adheres to the policies and procedures of Company
• Maintains strict confidentiality of client, company and personnel information
• Demonstrates a strong commitment to the mission and values of the organization
• Adheres to company attendance standards
• Performs other duties as assigned

HIPAA and Data Privacy Obligations:

This role has direct access to Protected Health Information (PHI). The following rules are non-negotiable:

• Absolute…