Funding Specialist Lead - West Region

Duties and Responsibilities / Essential Functions

• Develops and maintains working knowledge of current durable medical equipment and policies and procedures held by National Seating & Mobility as well as all applicable insurance guidelines regarding eligibility for coverage and reimbursement.
• Ensures compliance with National Seating & Mobility policies and procedures.
• Manages transaction cycle time (TCT) from Coding and Pricing Complete to Documentation Complete, making certain that all necessary steps are taken in the appropriate order ensuring timeliness of process and quality of funding approval.
• Supports the Funding Specialist position due to PTO, LOA, FMLA, open positions and any other need as identified by the Division Funding Director, Funding Manager or Funding Supervisor.
• Communicates regularly and professionally with Referral sources, Physicians, Therapists, RTSs, and Clients to secure documentation as required by payer.
• Meets quality documentation follow-up attempt frequency and quality per policy following the escalation process.
• Requests, gathers, and reviews documentation for funding package and deferrals, including but not limited to: proper prescriptions, Letters of Medical Necessity (LMN), RTS evaluation information, price lists, forms (AOB, ABN, rent or purchase letter).
• Thorough review of all documentation received ensuring payer guidelines are met must be completed prior to satisfying the document in the work order.
• Gathers and verifies insurance coverage information and communicates benefits and coverage information to client.
• Maintains communication with client throughout the process when applicable, including notifying them of and collecting financial responsibility or guiding them through the hardship process, where allowed.
• Responsible for relationship management and funding related communication with Referral sources, Physicians, Therapists, RTSs, Clients and other internal and external customers.
• Follows the document collection Escalation Policy and communicates with all necessary parties per the guidelines.
• Communicates changes and escalations in the process and collects needed information from branch personnel, Referral sources, Physicians, Therapists, RTSs, and Clients.
• Coordinates with other funding areas and responsible for completing all tasks that need a Funding Action Required.
• Investigates and requests update of payer documentation requirements in the UPD.
• Ability to investigate issues and solve problems and concerns regarding any aspect of the Funding process.
• Completes other Funding tasks, as needed, including Coding and Pricing, Submissions, Authorization collection, PPQA and Delivery Verifications.
• Provides direction, instructions, and guidance to staff to achieve goals based on management direction.
• Ability to quickly learn and adapt to new assignments.
• Assists in documenting any best practices with clinicians for properly documentation procurement and identifies and coordinates any training opportunities, opportunities for improvements and UPD discrepancies or updates.
• Facilitates problem solving and collaborations.
• Motivates and inspires team members.
• Recognizes and celebrates team and team member accomplishments and exceptional performance.
• Assists in resolving customer complaints and concerns.
• Assists in fielding billing and payer concerns and correspondence.
• Supports the Division Funding Director, Funding Manager or Funding Supervisor in performance monitoring and evaluation process.
• Communicates team status, task accomplishment and direction to management.
• Performs routine auditing to assist in identifying coaching opportunities; Ensures the performance of staff is of a high standard.
• Occasionally may assist with new business acquisitions, branches that have temporary needs for processing.
• Performs other related duties and special assignments as requested.

Work Environment

This position primarily operates in a work from home environment. The work from home policy and requirements must be adhered to. Occasionally, 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 or 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

• Has minimum of 3 years of experience related to Durable Medical Equipment and/or Complex Rehab Technology required, preferred experience in all aspects of a Funding Specialist’s position including how to process both Repairs and Non-Repairs.
• Has extensive knowledge of the process and insurance guidelines to secure funding for Durable Medical Equipment and/or Complex Rehab Technology including comprehensive knowledge of insurance verification for DME.
• Experience with applications such as Mobility Advisor or data management systems required.
• Proven record of excellent people skills including good communication and inter-personal skills. Strong leadership skills.
• Strong Team Player.
• Strong organizational skills and attention to detail.
• Customer service driven.
• Excellent computer and technology skills including good knowledge of Microsoft Office applications, Outlook and Power Point; Experience with Excel to include spreadsheets and formulas and outlook email is required.
• Ability to be a strong role model for high performance and productivity.
• Ability to manage and develop others remotely.
• Ability to read, analyze and interpret general business reports, technical procedures, work instructions, and governmental regulations.
• Ability to write reports, business correspondence, and develop training materials.
• Ability to effectively present information and respond to questions from a variety of staff.
• Basic understanding of and willingness to learn and adopt professional and industry standards.