MIR Specialist

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 correcting and reworking any order that is unable to be billed or has resulted in a claim denial due to missing or incorrect information. This can include 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

• Responsible for problem-solving, correcting, and reworking any order that is unable to be billed or has resulted in a claim denial due to missing or incorrect information.
• Ensures the accuracy of and completes updates to all required coding, modifiers and pricing.
• Verifies client benefits and coverage and communicates benefit information to client.
• Gathers and reviews documentation for payer, 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.
• Maintains communication with client throughout the process when applicable, including notifying them of financial responsibility.
• Coordinates with branch staff to secure pick up and redelivery documentation as required.
• When appropriate, discusses and secures approvals to write off or adjust balances.
• Communicate with Billing and Collection team to ensure that timely filing deadlines are met and/or to resolve any clarification on MIRs.
• Properly noting and closing MIRs with a complete and thorough response through the Funding Portal and Mobility Advisor.
• Performs any related job duties assigned by the MIR Manager. 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 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.
• Proficient in Microsoft Excel, Word, and Outlook.
• Strong ability to problem solve, knowledge of NSM P&P and ability to interpret and follow payer guidelines and all Policies and Procedures.