Remote Utility Processor – Job Description
INTERNAL APPLICANTS ONLY
The Remote Utility Processor is completely responsible for life cycle of a client’s order from the time our Rehab Technology Specialists turn the order over after client evaluation up to the time of verifying the final steps for delivery. As a Remote Utility Processor your processing assignment will be provided by your Supervisor and may change on a daily, weekly, monthly basis dependent upon the needs of the Region/Area. In addition, while you will be mainly be assigned to a specific area (Pacific or South Mountain), based on the need of the Region, you may be tasked to a different area within the Region.
Daily duties include but are not limited to:
• Reviewing new orders to ensure that we have all manufacturer quotes and labor detail
• Verifying insurance eligibility
• Review ordered components and determine proper ICD-10 coding and payer reimbursement amounts
• Coordinating benefits between payers if there are multiple.
• Contacting physicians, Therapists and Managed Care facilities to obtain proper documentation such as Letters of Medical Necessity, Rx, Chart Notes and any additional documents required by the payers for payment authorization.
• Preparing funding packages for submission to payers for prior authorization
• Submit funding packages to payers for authorization
• Following up with all payers on an order to check the status on authorizations
• Reviewing received authorizations and/or denials for accuracy ensuring number of units, coding and dates match the request. If denied, gather requested information and resubmit.
• Update orders with authorizations received and notifying purchasing department to purchase
• Once all order components are in stock, verify insurance eligibility one last time and confirm order is approved for delivery.
• Work MIR and FEA reports for the assigned responsibility
• Overtime as needed and approved to ensure 100% compliance
• Attend weekly phone meetings with RTS/ATP of current assignment
• Attend weekly phone meetings with Utility Supervisor
• Provide training/mentoring to new region staff as directed by the Utility Supervisor
This is a remote position, not a work-from-home position. An applicant that resides within 30 miles of a branch must work from the branch. This position reports directly to the Utility Processing Supervisor and has no direct reports.
Performance will be monitored on a daily/weekly basis by the Utility Processing Supervisor. Position may be measured by, but not limited to, the following performance standards:
• Minimum approval volume
• Minimum submission volume
• Region order compliance standards
Applicants must have a minimum of 2 years-experience working as a funding specialist for NSM with a proven track record of exemplary performance.
This position does not require travel. However, there may be times where a new processor would travel to you for training and there is the potential for once-a-year travel to the Utility Hub for launch/kickoff meetings.
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