DME Services Manager

Description

Founded in 1991, IBJI is the largest orthopedic group practice in Illinois. With more than 150 physicians in every orthopedic specialty, IBJI offers care for adults and children from some of the most accomplished and respected orthopedists in the country. Serving northern Illinois and northwest Indiana with over 100 locations, IBJI makes it easy to access care. Our headquarters is in Park Ridge, Illinois, a northwest suburb of Chicago. Our clinical services include advanced MRI imaging, pain management, non-surgical and surgical treatment plans, rheumatology, physical therapy, occupational therapy, wellness, and sports training. Ortho Access walk-in clinics provide same day care for orthopedic injuries. Beginning in 2021, IBJI expanded its clinical model to include eight outpatient ambulatory surgery centers that serve as an alternative to the traditional hospital model, enabling physicians, therapists and staff to work closely together to achieve better patient outcomes and convenience. Comprehensive care offered all in one place enables physicians, therapists and staff to work closely together, so that patients and families achieve better outcomes. Collaborative care is also more efficient. In many cases, IBJI services are substantially less expensive than those provided by large healthcare systems and emergency rooms.

Summary

The objective of the DME Services Manager is to provide support, general oversight and appropriate interventions relative to assigned DME Service Centers and DME Services Coordinators. He/She will also provide expertise related to clinical and documentation as it relates to all of IBJI DME. The Goal of the position is to ultimately provide support and guidance to the extent that it yields excellence in IBJI’s DME service line that is consistently tied to our 3 core values and Mission Statement.The position is under the general direction of the Director of Purchasing. 

Responsibilities

• Directly oversees DME Services Coordinators (DME SC)
• Responsible for Financial Performance of DME Service Centers in conjunction with DME SC
• Responsible for assisting in Budget development with the Director of Purchasing
• Responsible for Professional Level Staffing Interview and Hiring. Final approval of professional staff positions and progression to Corporate activation is the responsibility of the Director of Purchasing
• Approval of DME SC PTO and CEU
• Approval of Capital Expenses related to assigned Service Centers that exceeds $250
• Works in collaboration with RCM to address any audits that are related to IBJI DME.
• Works in conjunction with Compliance, Coding, and Legal to ensure DME compliance: Develops Path Training as needed, Trains IBJI staff on Epic 
• Responsible for overall coordination and processing of new patient DME orders including:Pre-verification of insurance benefits, obtaining an estimate of benefits and pre-certification of claims as required
• Translating and entering prescriptions into the company information system
• Obtaining authorizations and communicating out-of-pocket estimates to patients
• Ensure that all necessary documentation is obtained as it relates to payer requirements, standard operating procedures, and IBJI compliance program. Assists and helps coordinate with the DME Audit Process in conjunction with 
• Maintain good communication with physicians and administration as it applies to DME products (new products/product availability) and all documentation needed to process patient insurance claims
• Monitor and analyze new item requests for necessity and profitability from physicians and patients
• Accurately maintain billing and coding according to Medicare regulations IBJI standards Coordinate with outside vendors to be sure we have the most up-to-date information for billing and coding of products
• Manage and track patient billing information; work in coordination with HIS billing/collections department to ensure timely billing and appeals process
• Ensure all physicians and staff are educated on all DME products and documentation needed to comply with the billing standards of all insurance carriers
• Work with both internal and external customers to ensure that orders are processed in a timely manner
• Meet performance goals of both IBJI and the client
• Educate patients on insurance plans and provisions and financial responsibility of the patient portion
• Actively promote and foster good relations inter-departmentally and with administration, payers, suppliers, physicians, clinical staff and surgery center personnel
• Track, maintain and order assets for all physician locations including inventory and equipment
• Manage profitability at all physician locations
• Comply with all elements of HIPAA, Medicare, Medicaid, and other required programs
• Develop and maintain site specific operational manuals
• Communicate effectively with patients, family, outside contacts, medical staff, care team members and supervisor
• Complete administrative and other responsibilities in support of the department as assigned by the supervisor
• Coordinate training for staff with outside vendors as well as internal training on procedures and ongoing improvements
• Manage all aspects of the order fulfillment process for the physicians, their staff and clients to ensure a smooth operation with highest levels of customer service and product availability when needed at all physician locations
• Establish and manage relationships with outside vendors; coordinate training of staff, education of medical team and new product information with these vendors
• Cross-train to other functions, as necessary
• Define and implement a best practice model for the clerical area
• Assures that professional and support staff properly implement and execute policies and procedures
• Evaluate, counsel and promote the growth and development of the staff
• Coordinate, develop and maintain quality assurance and program evaluation systems
• Work with the administration and physicians to formulate a marketing plan to position the facility as the DME provider of choice in the area
• Interact with internal/external customers and professional associations to gather input on this plan
• Organize outside coverage for staff vacations, ensuring temporary employees are trained for all situations in DME Services
• Coordinate with administration to help enhance DME Services and extend to other IBJI Locations
• Maintain a clean and safe work environment
• Other duties as assigned

Requirements

Requirements

Education

• High school diploma or equivalent

Certifications/Licensure

• Licensed or NATABOC Certified Athletic Trainer, Certified Orthotic Fitter, Orthopedic Technician, Physical Therapy Tech, Medical Assistant or comparable professional medical certification preferred

Experience

• Minimum of 2-3 years experience in healthcare management with exposure to insurance verification, claims submission and inventory management
• Experience working in a DME providers office, physicians office, hospital, or insurance company in a similar role
• Experience with the procurement and insurance processing of durable medical equipment preferred
• Experience in dealing with self-pay, private insurance and government programs required

Technical Skills

• Basic mathematical skills
• Proficiency with business and communication software including MS Office (Word, Excel, PowerPoint, and other related programs), Google Suite (Google Docs, Sheets), and general business equipment (facsimile, copier, printer, etc.)
• Demonstrate a working knowledge of ICD-10, CPT, and HCPCS codes, HIPAA laws, medical terminology and anatomy
• Knowledge of DME accreditation a plus
• Working knowledge of distribution, inventory control, and purchasing systems

Soft Skills

• Excellent organizational and communication skills (verbal and written)
• Ability to perform job functions as multiple sites requiring automotive transportation
• Self direction essential 

Physical Requirements

• Stand or sit for extended periods of time
• Demonstrates good understanding of proper body mechanics for lifting, pulling, pushing
• Ability to be standing and sitting for sequences of time greater than 30 minutes
• Ability to work on a computer for lengthy times during the day

This description is intended to provide only basic guidelines for meeting job requirements. Duties and responsibilities, experience, qualifications, skills, supervisory relationship, physical/mental demands, and environmental/ working conditions may change as needs evolve.

Base salary offers for this position may vary based on factors such as location, skills and relevant experience. We offer the following benefits to those who are benefit eligible (30+ hours a week):  medical, dental, vision, life and AD&D insurance, long and short term disability, 401k program with company match and profit sharing, wellness program, health savings accounts, flexible savings accounts, ID protection plan and accident, critical illness and hospital benefits. In addition, we offer paid holidays and paid time off.  

Illinois Bone and Joint Institute, LLC is an equal opportunity employer. All employment decisions are based on qualifications, merit, and business need, without regard to race, color, religion, age, sex, national origin, disability status, military or veteran status, sexual orientation, gender identity and expression, or any other characteristic protected by federal, state or local laws. This policy applies to recruitment and placement, promotion, training, transfer, retention, rate of pay and all other terms and conditions of employment.