Durable Medical Equipment (DME) Specialist, REMOTE Job Vacancy in AmeriHealth Caritas Philadelphia, PA – Latest Jobs in Philadelphia, PA – updated today

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Company Name : AmeriHealth Caritas
Location : Philadelphia, PA
Position : Durable Medical Equipment (DME) Specialist, REMOTE

Job Description : Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.
Responsibilities:

Under the general supervision of the Supervisor, UM Review, responsible for intake of requests for Durable Medical Equipment including telephone support, data entry, submission to AmeriHealth Caritas Health Plan Medical Directors for medical necessity review, completion of service authorization detail lines, and member/provider notification process.

Responsible for precertifcation and recertification process for Durable Medical Equipment.
Follows departmental workflow for prior authorization of request, including documenting receipt of request, member eligibility, submitted information in the AmeriHealth Caritas Health Plan Utilization Management software system.
Authorizes services based on AmeriHealth Caritas Health Plan Guidelines. If unable to approve, submits the request to AmeriHealth Caritas Health Plan Medical Director for medical necessity determination.
Completes detail lines in Utilization Management software system to reflect authorization or denial of services.
Follows denial process to provide initial verbal/facsimile notification to providers/members and generates appropriate written notification to providers/members.

Education/Experience:

High School Diploma or GED required. Associate’s Degree preferred.
1-3 years general office and/or customer service experience desired.
Minimum 1 year experience in a healthcare related field such as Home Health Agency, Medical Equipment, or managed care organization.
Proficiency with Microsoft Office Suite, specifically Word, Outlook, and Excel, within a Windows based environment.
Familiarity with electronic medical record (EMR) and documentation programs desired.

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Post Tags : , Philadelphia, PA, jobs in Philadelphia, PA, Durable Medical Equipment (DME) Specialist, REMOTE jobs in Philadelphia, PA

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