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Durable Medical Equipment (DME) Analyst – eviCore – Remote
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The Durable Medical Equipment (DME) Analyst delivers professional activities in the Business Analytics job family. Analyzes data to inform business and product decisions. Conducts data mining, routine analyses and compiles standard reports. Blends historical data from available industry reports, public information, field reports, or purchased sources as input to analyses. Applies standard techniques and procedures to routine instructions that require professional knowledge in specialist areas. Provides standard professional advice and creates initial reports/analyses for review.
What you must have
- Associates degree or higher, preferred
- Healthcare experience, preferred
- Experience with Durable Medical Equipment, preferred
- Knowledge of HCPCS codes and healthcare, preferred
- Advanced knowledge of Excel
- Ability to manage one’s time and resources to ensure that work is completed efficiently
- Ability to provide clear verbal and written communication via in-person, email, and phone to customers, co-workers, and leadership
- Ability to choose a course of action or developing appropriate solutions by identifying and understanding issues, problems, and opportunities
- Ability to work independently with little to no supervision
- Ability to pay very close attention to detail and well organized
- Technical Skills: proficient computer literacy with ability to use Microsoft Word, Outlook, and Visio
- Experience using videoconferencing systems such as WebEx Teams, preferred
- Ability to demonstrate knowledge and understanding of cultural competency and complies with privacy policies and practices
- Proactively communication regarding existing or potential issues and solicits support to help bring issue to resolution
Duties and Responsibilities
- Stay up-to-date with AMA, CMS, and State regulation in regards to new, term, and description changes on HCPCS codes
- Stay current with CMS and State regulations on HCPCS codes including but not limited to max quantity, non-covered codes, rental vs purchase
- At least annually investigate and compare data in regards to the fee schedule, denial vs approval rate, utilization, and claims data on all delegated HCPCS codes
- Create and provide notification to clients and internal teams with changes to HCPCS codes
- Maintain eviCore’s and all clients master HCPCS list, including a change log, with any changes including but not limited to prior auth vs no prior auth, Primary Service Type, Class, Subclass, and Crossovers on eviCore’s SharePoint site
- Maintain rulesets for each HCPCS code for eviCore’s master list and all clients master list
- Maintain a list of any special contract negotiations or carve outs with clients and DME suppliers
- Schedule and facilitate track 2 calls for HCPCS codes that are new per CMS or AMA, HCPCS codes that are being added by a client or eviCore, or any HCPCS code being termed/removed
- Maintain current operating procedures, adherence to policy & procedures, and assisting in creating new workflows to meet the programs evolving needs
- Investigate concerns and questions in regards to HCPCS code ruleset coverage for all clients and internal teams
- Maintain HCPCS benefit denials process
- Maintain OON process for all clients including no prior auth codes
- Work effectively and collaborate with other individuals and teams
- Other duties as required
- This role is WAH which allows work to be performed at home
- Hours: Monday - Friday; 8:00 am - 5:00 pm (your time zone)
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an hourly rate of 26 - 39 USD / hourly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Company Group.
About Evernorth Health Services
Evernorth Health Services, a division of The Company Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: ___@___(apply_to_show_email) for support. Do not email ___@___(apply_to_show_email) for an update on your application or to provide your resume as you will not receive a response.
The Company Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
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