Funding Specialist II - West Region

Statement of the Position

Coordinates with the Funding Manager, Funding Supervisor, Branch Manager, Rehabilitation Technology Supplier (RTS), and other office support personnel to ensure all operational procedures are completed in accordance with company policy and within expected time frames. Responsible for the complete funding transaction cycle including Coding & Pricing, gathering information and documents pertinent to the funding package, ensuring that all documentation is in place, submission to the funding sources and collecting payer decisions including authorizations, denials, and deferrals.

Duties and Responsibilities / Essential Functions

• Manages transaction cycle time (TCT) from Ready to Process to Final Funding Approval, making certain that all necessary steps are taken in the appropriate order ensuring timeliness of process and quality of funding approval.
• Obtains any required missing demographics and ensures that all client information (Minimum Documentation Requirement) is correct and is put into the work order.
• Verifies client benefits and coverage and communicates benefit information to client.
• Gathers and reviews documentation for funding package, including but not limited to: proper prescriptions, Letters of Medical Necessity (LMN), RTS evaluation information, price lists, forms (AOB, ABN, rent or purchase letter).
• Communicates regularly with Physicians, Therapists, RTSs, and Clients in an effort to secure documentation as required by payer.
• Communicates changes and escalations in the process and collects needed information from branch personnel, Referral sources, Physicians, Therapists, RTSs, and Clients.
• Investigates and updates any payer requirements in the UPD.
• Maintains communication with client throughout the process when applicable, including notifying them of financial responsibility.
• Follows up with payer sources in order to obtain timely authorization, by properly working the Funding Work Queue.
• Requests and obtains proper approval for work order credit exceptions.
• Conducts pre-purchase quality assurance to ensure all approvals and requirements are met prior to purchase of equipment.
• Conducts pre-delivery verification to ensure all approvals and requirements are met prior to delivery of equipment.
• Coordinates with other funding areas and responsible for completing all tasks in the Action Required queue.
• Performs any related job duties assigned by the Funding Manager or Funding Supervisor. Carries out all position expectations in a professional manner and with minimal supervision.
• Responsible to complete all continuing education requirements to include assigned NSM University courses.
• Must maintain regular and predictable attendance.

Work Environment

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, printers, photocopiers, filing cabinets and fax machines.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. The employee is regularly required to sit; use hands repetitively to operate standard office equipment. The employee is frequently required to reach with hands and arms.

Required Education, Experience, & Competencies

• 2 years’ experience in Complex Rehab Technology, Medical Billing, or Funding preferred
• High school diploma or G.E.D.
• Proficient in Microsoft Excel, Word, and Outlook