About this role
• Acts as patient navigator to set up appointments, obtain referrals, related medical records. Performs benefit investigation
• Responds to all Incoming calls for Sleep patients. They schedule all appointments, billing and insurance inquiries
• Schedules DME setups- coordinates between patient, department and DME or required DME vendor-depending on patient zip-code.
• Works with FCC on authorizations for home sleep tests-tracks orders and authorizations while maintaining communication with patients during this process.
• Processing orders for CPAP machine and supplies-this entails filling out required paperwork, forms, and sending required medical records to DME vendor in order for insurance to cover. All plans have different rules and requirements and they must be well versed in all the insurance coverage policies. They must also know what DME equipment is covered by each insurance company.
• Works with Sleep Educator to schedule patient once DME equipment is approved and received.
• Coordinates provider appointments after equipment is received. Per Medicare guidelines patients must be seen between 31 and 90 days of receiving equipment. If patients are not seen in this timeframe, they are deemed “non-compliant” and the entire process must be repeated.
• They act as Customer Service Representatives for sleep patients. They address all patient concerns related to equipment, coverage, or benefits and relays information to physicians, clinical staff or DME company as indicated.
• Schedules peer to peers insurance reviews and submits all paperwork for insurance/coverage appeals for insurance denials.
• Investigates and tracks charts for sleep studies and machines in order to receive payment through DME company.
• Performs other duties as assigned by the Sleep Wellness Coordinator.