HME Quality Assurance Specialist

Job description

Overview The Quality Assurance Specialist is responsible for obtaining and maintaining accurate information for each home medical equipment referral/order received based on the payers’ guidelines and specified criteria. The Quality Assurance Specialist will ensure compliance is maintained for cpap, oxygen, oxygen recertifications, prior authorizations, etc... The Quality Assurance Specialist will utilize the information listed in the Medicare Supplier Manual, the Local Coverage of Determination, the Articles and the Program Integrity Manual to determine the appropriate data to be collected and to insure that all coverage and billing criteria is met. Major responsibilities include confirming orders to bill that have accurate documentation. Correcting and verifying billing issues causing orders to be stopped or put on hold is a daily task for the Quality Assurance Specialist. The Quality Assurance Specialist will research payment denials, create deposits for remits and request additional documentation that may affect the order from billing out correctly. Validating compliance for Equipment Maintenance and Insurance Audits are what the Quality Assurance Specialist will ensure. Obtaini...