Durable Medical Equipment Consultant

🔥 0 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $64.5k - $92.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Healthcare Insurance • Human Services • Healthcare

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• 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