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Medical Home Modification Project Specialist

Status: Full Time
Posted: 3/15/2017
Location: Waterloo, Iowa

Job Description:

Job Purpose Summary:

Coordinates the delivery of a full spectrum of home and vehicle modification services.  Verification of insurance coverage from payer sources while working with healthcare providers and payer sources to ensure patients receive a high standard of service delivery and care, which includes ensuring that patients receive the necessary medical equipment, services, proper instruction, and quality customer service by the expected delivery date.

The Complex Care Support Specialist will serve as floater, as needed, for the CAT Team. The Complex Care Support Specialist works collaboratively to arrange multi-services with the injured worker, family, physicians, nurse case manager, social worker, claims adjuster, and other healthcare team specialists to ensure the member progresses towards care goals and receives medically appropriate services.

*Key Responsibilities:

The Home Modification Project Specialist position may include one or more of the following key responsibilities:

  1. Ability to function in a call center environment, answer calls from referral sources in a timely and professionally manner, and secure referral orders by telephone, fax, and electronic means
  2. Contacts payer sources to verify or obtain benefits/authorization for items or services requested
  3. Coordinates the delivery of medical equipment and other healthcare services, including contacting the patient, provider, or on-line tracking system to confirm items were delivered or services rendered
  4. Obtains and sends appropriate clinical documentation to payer sources by fax or electronic means to assist them in determining the medical necessity of medical equipment and other healthcare services
  5. Communicates with supervisor, other PCC’s, and external parties to keep them informed of order status, including outlying situations that could affect the referral
  6. Collects and enters accurate and detailed patient, provider, and payer information into the Company’s claims platform on a real-time basis to prevent delays in billing or services
  7. Answers questions from patients, providers, Company staff, and payer sources
  8. Ensures patients receive a high standard of service delivery and care through a series of quality questions to ensure Company quality standards are being met
  9. Identifies and resolves service issues and complaints
  10. Intake of new orders as needed during busy times, even if not the primary job responsibility of the Home Modification Project Specialist
  11. Knowledge of Company policy and procedures and regulatory, contractual, and accreditation requirements
  12. Follows strict confidentiality and HIPAA privacy and security guidelines
  13. Reviews orders to ensure they are setup with accurate coding, quantity, and pricing
  14. Availability for after hours on-call coverage
  15. Performs other duties as assigned

*Key responsibilities do not include conducting utilization management activities that require clinical judgement or interpretation of clinical information, including issuing denials of service authorization requests

The Reauthorization Home Modification Project Specialist performs the following key responsibilities:

  1. Works closely with insurance case managers, adjusters, representatives, and providers to obtain authorization of medical equipment and other health care services
  2. Contacts the physician’s office, provider, and patient to determine if the medical equipment or healthcare services are still needed prior to an authorization expiring
  3. Obtains continued authorization from payer sources for medical equipment and other healthcare services by collecting and sending the appropriate prescriptions, clinical records, and other forms of medical necessity documentation
  4. Completes discharge requests when rental items or healthcare services are no longer needed
  5. Collects and forwards progress notes and other clinical records to Clinical Review Nurses
  6. May be required to perform the responsibilities of an Outbound PCC as needed

Key Qualifications:

  1. Customer service focused
  2. High degree of integrity and trust
  3. Ability to multitask and prioritize
  4. Possesses strong time management and organization skills
  5. Detailed oriented
  6. Works well under pressure and is punctual
  7. Flexible with the ability to routinely adapt to change
  8. Team player with excellent communication skills
  9. Knowledge of various healthcare industry billing and/or coding terminologies such as ICD-10, HCPCS, CPT, modifiers, and various Medicare NCD’s and LCD’s


  1. High school diploma or GED
  2. Must comply with continuing education per Company, regulatory, contractual, and accreditation requirements

Physical Requirements:

  1. Sitting at desk, standing, and walking in office and throughout facility
  2. Operation of office machinery and equipment
  3. Visual abilities to include reading, distance vision, and peripheral vision

This job description reflects the general duties of the job but is not a detailed description of all duties which may be inherent to the position. Reasonably related additional duties may be assigned to the individual Associate.

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