Lead MIR Specialist

Statement of the Position:

Coordinates with the Funding Manager, Funding Supervisor, Branch Manager, Rehabilitation Technology Supplier (RTS), and other office support personnel to ensure all operational procedures are completed in accordance with company policy and within expected time frames. Responsible for correcting and reworking any order that is unable to be billed or has resulted in a claim denial due to missing or incorrect information. This can include Coding & Pricing, gathering information and documents pertinent to the funding package, ensuring that all documentation is in place, submission to the funding sources and collecting payer decisions including authorizations, denials, and deferrals.

Company Description:

At all levels, working at National Seating & Mobility provides the opportunity to directly impact our client’s lives by giving them self-reliance and independence. Our teams are comprised of passionate individuals, dedicated to providing the best care to each client. We focus on abilities by leveraging technology and creating mobility solutions that are as unique as our client’s needs.

Working at National Seating & Mobility is an opportunity to build a meaningful career, while leaving a lasting impact on the lives of those we serve. Located in more than 40 states, we strive for diversity and offer an array of benefits including 401k, company paid Long Term Disability, and tuition reimbursement.

Duties and Responsibilities / Essential Functions:

1. Develops and maintains working knowledge of current durable medical equipment and policies and procedures held by National Seating & Mobility as well as all applicable insurance guidelines regarding eligibility for coverage and reimbursement.

2. Ensures compliance with National Seating & Mobility policies and procedures.

3. Supports the MIR Specialist position due to PTO, LOA, FMLA, open positions and any other need as identified by the MIR Team Manager.

4. Responsible for problem-solving, correcting, and reworking any order that is unable to be billed or has resulted in a claim denial due to missing or incorrect information.

5. Ensures the accuracy of and completes updates to all required coding, modifiers and pricing.

6. Verifies client benefits and coverage and communicates benefit information to client.

7. Gathers and reviews documentation for payer, including but not limited to: proper prescriptions, Letters of Medical Necessity (LMN), RTS evaluation information, price lists, forms (AOB, ABN, rent or purchase letter).

8. Communicates regularly with Physicians, Therapists, RTSs, and Clients in an effort to secure documentation as required by payer.

9. Communicates changes and escalations in the process and collects needed information from branch personnel, Referral sources, Physicians, Therapists, RTSs, and Clients.

10. Investigates and updates any payer requirements.

11. Maintains communication with client throughout the process when applicable, including notifying them of financial responsibility.

12. Coordinates with branch staff to secure pick up and redelivery documentation as required.

13. When appropriate, discusses and secures approvals to write off or adjust balances.

14. Communicate with Billing and Collection team to ensure that timely filing deadlines are met and/or to resolve any clarification on MIRs.

15. Properly noting and closing MIRs with a complete and thorough response through the Funding Portal and Mobility Advisor.

16. Provides direction, instructions, and guidance to staff to achieve goals based on management direction.

17. Ability to quickly learn and adapt to new assignments. Assists in documenting any best practices with clinicians for properly documentation procurement and identifies and coordinates any training opportunities, opportunities for improvements and UPD discrepancies or updates.

18. Facilitates problem solving and collaborations.

19. Motivates and inspires team members.

20. Recognizes and celebrates team and team member accomplishments and exceptional performance.

21. Assists in resolving customer complaints and concerns.

22. Assists in fielding billing and payer concerns and correspondence.

23. Supports the MIR Team Manager in performance monitoring and evaluation process.

24. Communicates team status, task accomplishment and direction to management.

25. Performs routine auditing to assist in identifying coaching opportunities; Ensures the performance of staff is of a high standard.

26. Occasionally may assist with new business acquisitions, branches that have temporary needs for processing.

27. Performs any related job duties assigned by the MIR Manager. Carries out all position expectations in a professional manner and with minimal supervision.

28. Responsible to complete all continuing education requirements to include assigned NSM University courses.

29. Must maintain regular and predictable attendance.

Work Environment:

This position primarily operates in a work from home environment. The work from home policy and requirements must be adhered to. Occasionally, this job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, printers, photocopiers, filing cabinets and fax machines.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is regularly required to sit; use hands repetitively to operate standard office equipment. The employee is frequently required to reach with hands and arms.

Required Education, Experience & Competencies:

1. Has minimum of 3 - 5 years of experience related to Durable Medical Equipment and/or Complex Rehab Technology required, preferred experience in all aspects of a Funding Specialist’s position including how to process both Repairs and Non-Repairs.
2. Has extensive knowledge of the process and insurance guidelines to secure funding for Durable Medical Equipment and/or Complex Rehab Technology including comprehensive knowledge of insurance verification for DME.
3. Experience with applications such as Mobility Advisor or data management systems required.
4. Proven record of excellent people skills including good communication and inter-personal skills.
5. Strong leadership skills.
6. Strong Team Player.
7. Strong organizational skills and attention to detail.
8. Customer service driven.
9. Excellent computer and technology skills including good knowledge of Microsoft Office applications, Outlook and Power Point; Experience with Excel to include spreadsheets and formulas and outlook email is required.
10. Ability to be a strong role model for high performance and productivity.
11. Ability to manage and develop others remotely.
12. Ability to read, analyze and interpret general business reports, technical procedures, work instructions, and governmental regulations.
13. Ability to write reports, business correspondence, and develop training materials.
14. Ability to effectively present information and respond to questions from a variety of staff.
15. Basic understanding of and willingness to learn and adopt professional and industry standards.