DME & Home Health Coordinator

Job Summary

The DME and Home Health Coordinator serves as a liaison between patients, providers, specialists, insurance carriers, and community agencies to ensure timely coordination of Durable Medical Equipment (DME), Home Health services, Specialty Services, and other authorized healthcare services. This individual is responsible for facilitating prior authorizations, monitoring referrals, coordinating care, and advocating for patients throughout the authorization and referral process.

The ideal candidate is detail-oriented, organized, and able to function effectively in a fast-paced environment while maintaining a high level of professionalism and compassion. The Coordinator must possess strong communication skills, the ability to prioritize multiple tasks, and a commitment to delivering excellent patient care and customer service. This position requires independent judgment, sound problem-solving skills, and the ability to collaborate effectively with providers, patients, families, insurance carriers, and community partners.

Communication

Excellent oral and written communication skills are required for this position. The individual must communicate effectively and professionally with patients, families, providers, staff, insurance representatives, and external organizations while maintaining confidentiality and demonstrating tact and empathy. The ability to communicate in Spanish, Creole, or both is preferred.

Key Responsibilities

• Complete prior authorization processes for Durable Medical Equipment (DME), Home Health services, Specialty Services, and, in some cases, medications.
• Conduct telephonic discussions with healthcare providers, patients, family members, and insurance carriers to obtain clinical information and explain authorization or coverage determinations.
• Maintain ongoing tracking and documentation of referrals, authorizations, and benefit determinations, including coverage guidelines, contractual limitations, and reimbursement decisions, to promote team awareness, continuity of care, and patient safety.
• Work independently while collaborating with medical providers and non-clinical partners to coordinate patient care and ensure timely access to services.
• Act as a patient advocate with insurance carriers, when appropriate, to help secure timely approval of medically necessary supplies and services.
• Serve as the system navigator and primary point of contact for patients and families, providing direct access for questions, education, and assistance with care coordination.
• Monitor referral and authorization statuses, following up as needed to prevent delays in patient care.
• Ensure the patient's electronic health record (EHR) is updated with information regarding specialist consultations, hospitalizations, emergency room visits, and community organizations involved in the patient's care.
• Document all patient contacts, communications, and progress accurately and thoroughly within the EHR.
• Adapt to changing priorities and manage a high-volume workload efficiently while maintaining accuracy and attention to detail.
• Demonstrate proficiency in computer applications including Microsoft Word, Excel, Outlook, Windows, and electronic health record systems.
• Perform other duties and responsibilities as assigned.

Education & Training

• High School Diploma or GED required.
• Associate degree in Healthcare Administration, Medical Assisting, Health Information Management, or a related healthcare field preferred.
• Certification as a Medical Assistant, Referral Coordinator, or other healthcare-related certification is preferred but not required.
• Ongoing continuing education related to healthcare coordination, insurance authorization processes, or patient care is encouraged.

Experience

• One to three years of progressive experience in a medical office, referral department, utilization management, care coordination, DME, Home Health, or insurance authorization setting required.
• Experience working with insurance carriers, prior authorizations, referral management, and electronic health records preferred.
• Knowledge of Medicare, Medicaid, and commercial insurance authorization processes preferred.

Requirements

• Level 2 background clearance required.
• Proof of immunizations for MMR, Hepatitis B vaccination, and either a history of chicken pox (Varicella) or documentation of Varicella vaccination, current Tdap, and PPD test at time of hire.
• Ability to maintain confidentiality and comply with HIPAA regulations.

WFHC reserves the right to change or modify the job description, including but not limited to Major Responsibilities, Education, Certification, and Physical Requirements.

WFHC is an EOE.

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