Durable Medical Equipment (DME) Coordinator-Lead

JOB SUMMARY/PURPOSE Serves as a single entry or "easy access" point to help members, providers and vendors navigate through managed care as related to Durable Medical Equipment (DME).
Applies knowledge of applicable regulations, contractual requirements and identified resources (internal or community partners) to facilitate access to appropriate cost-effective care and eliminate barriers where possible.
Acts as a lead/resource for department staff, which may include monitoring and training staff.
DEPARTMENT DESCRIPTION Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc.
(IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc.
offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan.
As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.
EXPERIENCE/EDUCATION/QUALIFICATIONS Bachelor's degree in health related field or equivalent DME experience required.
Five (5) years DME experience required.
Experience and/or training in the following areas required: CMS and OHP regulations related to DME.
Care management.
Electronic medical information systems and documentation.
Health plan benefit structure and policy.
CDME, RESNA, ATP or equivalent certification required.
Leadership experience preferred.
KNOWLEDGE/SKILLS/ABILITIES Effective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures.
Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.
Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.
PHYSICAL DEMANDS Rarely (1 - 10% of the time) Occasionally (11 - 33% of the time) Frequently (34 - 66% of the time) Continually (67 – 100% of the time) CLIMB - STAIRS LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs LIFT (Knee to chest: 24"-54") 0 – 20 Lbs LIFT (Waist to Eye: up to 54") 0 - 20 Lbs CARRY 1-handed, 0 - 20 pounds BEND FORWARD at waist KNEEL (on knees) STAND WALK – LEVEL SURFACE ROTATE TRUNK Standing REACH - Upward PUSH (0 - 20 pounds force) PULL (0 - 20 pounds force) SIT CARRY 2-handed, 0 - 20 pounds ROTATE TRUNK Sitting REACH - Forward MANUAL DEXTERITY Hands/wrists FINGER DEXTERITY PINCH Fingers GRASP Hand/Fist Location: Samaritan Health Services · SHS Health Plan Ops - Clin Ser Schedule: 1.
0 (80 hrs/pp), Day