Durable Medical Equipment Consultant
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Job Description
Durable Medical Equipment Consultant reviewing Medicaid Prior Authorizations based on medical necessity for Gainwell. Responsibilities include guidance for Medicaid Providers and analysis for process improvements.
Responsibilities:
- Review Medicaid Prior Authorizations based on medical necessity in accordance with State policy guidelines
- Provide guidance and support for Medicaid Providers
- Act as a clinical SME (or liaison) for internal Gainwell entities
- Adjudicating Durable Medical Equipment and prior authorizations based on medical necessity and eligibility
- Reviewing and evaluating prior authorization submissions
- Entering prior authorization outcome into the Medicaid Management Information System (MMIS) for processing
- Participation in monthly meetings with Gainwell leadership, operational staff support, clinical peers and State stakeholders
- Providing assistance and education to the provider community related to specific prior authorization submissions
- Offering analysis and recommendations to Gainwell and State leadership on methods and potential process improvements.
Requirements:
- Current Occupational Therapy, Physical Therapy or RN license in the state of WI
- Extensive experience in the DME field, including both the provision, delivery and appropriate pricing and coding of durable medical equipment
- Knowledge of and/or experience working with the Wisconsin Medicaid program
- Excellent interpersonal, oral, and written communication skills
- Ability to meet deadlines and manage priorities with minimal direct supervision.
- Experience working with various partners or team members toward shared goals.
Benefits:
- generous, flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
- leadership and technical development academies
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