Durable Medical Equipment Benefit Specialist
Primary Location Portland, Oregon
Worker Location Flexible
Job Number 1357506 Date posted 05/16/2025
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Description:
Job Summary:
This position is accountable for extending the administrative capacity of the Durable Medical Equipment (DME) Manager by assuming responsibility for day-to-day functions such as schedules, staffing, work-flow monitoring and assignments, training, metrics monitoring and measuring, etc. This work will be done in addition to providing the full-line of DME products and services to Kaiser Permanente Health Plan members as covered by the DME benefit including, but not limited to: prosthetics, orthotics, DME equipment and supplies, enteral, nutrition, and oxygen. To act as a resource for physicians, clinicians, health plan members and vendors throughout the region. To ensure orders are in compliance with local, state, and federal guidelines, billing instructions and limitations, and benefit eligibility. This position works under indirect supervision of the DME Manager in the DME department in support of the mission of the Northwest Region and through the commitment of organization funds in administering the DME benefit.
Essential Responsibilities:
- Represent functions of DME Benefit Coordinator II depending on work volume and demands of lead duties.
- Scheduling staffing for all employees within the department; approve time off requests and arrange for appropriate staffing levels. Create/adjust team work schedules. Ensure employees maintain appropriate work schedules. Take appropriate action concerning employees problems in absence of department manager.
- Orient, train, counsel and evaluate employees in accordance with department performance standards and agreements. Prioritize work flow and monitor employee progress, performance, productivity and performance. Identify and effectively resolve work group process issues; chair/facilitate/represent DME at assigned committee meetings. Work with the manager to identify and implement work process improvements and to ensure operational compliance to regulatory requirements.
- In addition to ensuring customer satisfaction by providing fast, reliable, courteous, auditable, appropriate service to our customers, handles escalated cases related to both internal and external customer service. Problem-solve, serve as a resource; provide information on products, services, and processes.
- Manage costs through effective utilization review of all requested equipment. Actively management databases and reporting to ensure compliance and timeliness. Determine appropriate action and assign responsibility for remediation as necessary. Perform audit follow up and communicate with vendors as needed.
- Resource Management: Proactively audit DME systems and data to look for unusual expense, utilization patterns, changes in trending, or any flags that warrant investigation. Identify cost saving/cost avoidance opportunities. Perform root cause analysis and make recommendations for resolution. Analyze performance data to valid operations assumptions or identify shifts in practice that drive cost or regulatory compliance issues. Develop, review, update and maintain all policies and procedures relating to DME. Educate/train employees on policies and procedures.
- Project Management: Serve as the department liaison for NW region initiatives. Represent DME operations and regulatory issues, act as a member of the regional team to design, develop and implement new systems, communicate to DME staff, interact with multiple people and departments throughout the organization.
- Perform other duties as assigned by supervisory personnel that are consistent with the individuals training and experience.
Basic Qualifications:
Experience
- Minimum one (1) year of experience working as a DME Coordinator II.
- Minimum two (2) year of experience with PCs/on-line computer systems.
- Minimum two (2) years of experience in a medical environment providing services to patients.
- Minimum two (2) years of experience in customer service.
Education
- Associate degree in healthcare related field OR two (2) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A
Additional Requirements:
- Demonstrated experience working independently in a multi-task environment.
- Medical terminology.
- Basic understanding of Medicare regulations, particularly as they pertain to the provision of Part B benefits.
- Basic understanding of Medicaid regulations for Oregon and Washington state.
- DME equipment/supply knowledge.
- Demonstrates customer-focused service skills.
- Excellent communication skills both oral and written.
- Keyboard proficient.
- Ability to maintain mature problem solving attitude when dealing with interpersonal conflict, difficult people, hostility or time demands.
- Commitment to task.
- Demonstrated effective decision making and problem solving abilities.
Preferred Qualifications:
- Minimum five (5) years of experience working in customer service.
- Minimum six (6) years of experience in the provision DME to patients either commercially or in another healthcare organization.
- Minimum two (2) years of experience with on-line systems.
- Minimum two (2) years of experience working as a Lead.
- Knowledge of Kaiser Permanente HR policies and procedures.
- Knowledge of the Kaiser Permanente systems and processes.
- Knowledge of HMO environment.
- HCPC coding knowledge
- Working knowledge of health plan benefits and policies.
- ICD10 coding.
- Spreadsheet proficient.
Primary Location: Oregon,Portland,Kaiser Permanente Building
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Flexible
Employee Status: Regular
Employee Group/Union Affiliation: NUE-NW-02|NUE|Non Union Employee
Job Level: Individual Contributor
Department: Kaiser Permanente Building - DME Administration - 1008
Pay Range: $27.06 - $35 / hour
Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.
Travel: No
Flexible: Work location is on-site at a KP location, with the flexibility to work from home.
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status. Submit Interest
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status. Submit Interest
