*DME Coordinator

Department: HS-Case Management
Location: Tampa, FL
Reports to: Dir, Product Operations

Evaluates the pre-service authorization request for Durable Medical Equipment, Orthotic and Prosthetics. Performs a unique role in reviewing records, uses subject matter expertise and compares information to established guidelines and the members benefit plan. Works closely with departmental clinical staff and management staff to impact the treatment plan and identify treatment plan alternatives.

Essential Functions:

  • Utilizes Well Care guidelines, CMS and State criteria, Fee Schedules along with subject matter knowledge to make authorization decisions and assist Medical Director with review determinations
  • Ensures accurate coding using most current coding guidelines. Documents all information accurately.
  • Corresponds and communicates with providers, vendors, members and various Wellcare departments.
  • Identifies and refers cases appropriate for case management.
  • Identifies potential quality of care issues and refers to Quality department.
  • Ability to follow and apply all necessary regulatory requirements for assigned market.
  • Assists with implementation of health care initiatives in market.
  • Assist in implementation of specific strategies of quality and outcomes of care.
  • Performs other duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED
    • Preferred An Associate's Degree in a related field
    Candidate Experience:
    • Required 3 years of experience in a managed care setting, medical office or facility setting with demonstration of medical administration duties
    • Preferred Other For FL MLTC, 2 years experience in managed long term care and/or coordination of benefits for dual eligible members
    Candidate Skills:
    • Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
    • Intermediate Demonstrated interpersonal/verbal communication skills
    • Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-10 coding
    • Intermediate Demonstrated written communication skills
    • Intermediate Ability to effectively present information and respond to questions from peers and management
    • Intermediate Ability to multi-task
    • Intermediate Other Work effectively within group to achieve desired outcomes
    • Intermediate Demonstrated interpersonal/verbal communication skills
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Intermediate Microsoft Outlook
      • Required Intermediate Microsoft Excel
      • Required Intermediate Microsoft Word

        About us
        Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.