Job Summary: Coordinates and administers Durable Medical Equipment (DME) Benefits to Kaiser Permanente Health Plan members including prosthetics, orthotics, DME equipment and supplies, enternals/nutritionals and oxygen. Acts as a resource for physicians, clinicians and health plan members throughout the region. Ensures orders are in compliance with Kaiser Permanente, Office of Medical Assistance Programs (OMAP) and Medicare guidelines, billing instructions and limitations, and benefit eligibility. Essential Responsibilities: + Procures and negotiates DME supplies, equipment and services. Reviews, validates and processes physician/clinician referral requests. Ensures member eligibility for DME services, both benefit and current Medicare guidelines. Contacts vendor, coordinates delivery and pick-up of equipment with vendor/clinician/patient. + Manages costs through effective utilization review of rental equipment. Determines need of rental equipment/supplies/oxygen. Works with appropriate clinician/physician to recommend cost-effective changes in service delivery. + Ensures customer satisfaction. Acts as a liaison for DME services to all customers in the supply chain, both internal and external to ensure customer satisfaction. Problem-solves, serves as resource, and provides information on products, services, and processes. + Researches and resolves invoice and claims discrepancies. Reconciles differences in quantity, description, or pricing of equipment/products and services. Analyzes and processes DME claims for reimbursement received from members, various KP departments and other sources. Investigates reasons for these claims, determines appropriate reimbursement, and authorizes payment. + Communicates, develops and maintains positive relations inter-regionally, intra-departmentally, and within the business community to insure professional and ethical business practices. + Provides ongoing system maintenance to the DME system to ensure the accuracy of the information. Ensures all claims systems have accurate Healthcare Common Procedure Coding (HCPC) codes and modifiers. + Monitors member eligibility and insure supplies are issued per benefit criteria. + Insures equipment is ordered and delivered in a time frame that mitigates inpatient costs and supports efficient discharge. + Makes recommendations as to potential new vendor sources or more efficient ways of doing business to reduce acquisition, labor and benefit costs. + Makes effective use of local and national contracts to lower program costs. + Denies equipment, supplies and products based on benefit coverage. + Approves or denies invoice payments. + Ensures procurement of timely responses from physicians in order to meet regulatory timeframes. Basic Qualifications: Experience + Minimum one (1) year of experience with PCs/online computer systems. + Minimum two (2) years of experience in a medical environment providing services to patients. + Minimum two (2) years of experience in customer service. Education + High School Diploma or General Education Development (GED) required. License, Certification, Registration + N/A Additional Requirements: + Demonstrated knowledge of and skill in customer-focused service, oral and written communication, problem solving, decision making and multi-tasking. + Demonstrated knowledge of Medicare regulations, particularly as they pertain to the provision of Part B benefits, DME equipment/supply knowledge. Preferred Qualifications: + Minimum five (5) years of experience in the provision of DME to patients either commercially or in another healthcare organization. + Minimum five (5) years of experience working in direct customer service. + Minimum two (2) years of experience with on-line systems. + Experience working with the elderly. + Demonstrated knowledge of and skill in Kaiser Permanente systems and processes, HMO environment, HCPC coding, health plan benefits and policies, IC-9 coding. + Demonstrated knowledge of and skill in Microsoft Excel. COMPANY: KAISER TITLE: DME Benefits Specialist LOCATION: Honolulu, Hawaii REQNUMBER: 1365441 External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.