Funding Payer 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 helping to secure a payer authorization and/or gathering information and documents pertinent to the funding package and ensuring that all documentation is in place to obtain quality authorizations for equipment and repairs. Acts as the account manager for assigned work orders by coordinating with other funding areas and completing all tasks through the assigned work queue(s) and/or by report.

Company Description

At all levels, working at National Seating & Mobility provides the opportunity to directly impact our client’s lives by giving them self-reliance and independence. Our teams are comprised of passionate individuals, dedicated to providing the best care to each client. We focus on abilities by leveraging technology and creating mobility solutions that are as unique as our client’s needs.

Working at National Seating & Mobility is an opportunity to build a meaningful career, while leaving a lasting impact on the lives of those we serve. Located in more than 40 states, we strive for diversity and offer an array of benefits including 401k, company paid Long Term Disability, and tuition reimbursement.

Duties and Responsibilities / Essential Functions

• Assists in managing transaction cycle time (TCT) from Ready to Submit 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.
•  Validates all required documents for submission to payer are present and complete. Coordinates with other funding teammates via Funding Action Required (FAR) process to secure missing documentation required for funding package or deferral, including but not limited to: proper prescriptions, Letters of Medical Necessity (LMN), RTS evaluation information, price lists, forms (AOR, AOB, ABN, rent or purchase letter).
• Verifies insurance coverage information and benefits, ensuring accuracy of information in work order.
• Requests and obtains proper prior authorization, pre-determination, and or denial notices as required by payer for all items on work order.
• Conducts post-authorization quality assurance to ensure all approvals or requirements are met prior to logging authorization.
• Communicates regularly with Payer and others as needed to secure authorization from payer.
• Communicates changes and escalations in the process and collects information from branch personnel, clients, and others as needed.
• Coordinates with other funding areas and is responsible for completing all tasks assigned through work queue(s) and/or by report.
• Investigates deferrals and submits updates for any payer documentation requirements in the UPD. Shares trends with Funding Leaders.
• Maintains communication with client throughout the process when applicable.
• Follows up with payer sources to obtain timely authorization, by properly working the work queue(s) and/or by report.
•  Meets quality follow-up attempt frequency and quality per policy following the escalation process. When necessary, attempts are to be made more often and as directed by the Funding Manager and/or Funding Supervisor.
• Performs any related job duties assigned by the Funding Director, Manager or Supervisor. Carries out all position expectations in a professional manner and with minimal supervision.
• Responsible for completing 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