Clinical Specialist
Hill-Rom Holdings, Inc. is the parent company for Hill-Rom’s operations and has been a leading worldwide manufacturer and provider of medical technologies and related services for the health care industry, including patient support systems, non-invasive therapeutic products for a variety of acute and chronic medical conditions, medical equipment rentals, and information technology solutions since 1929.
Hill-Rom Holdings, Inc. (NYSE:HRC) currently employs more than 6,500 people worldwide, including approximately 2,000 at its global headquarters. Our mission is simple: Every day we strive to make a positive difference in the lives of patients and those who care for them.
Hill-Rom offers its associates challenging work experiences, a collaborative team environment, and an atmosphere to continually develop your career. However, the strongest reason for working at Hill-Rom is the opportunity to put your passion for making a difference to work.
We are currently seeking a Clinical Specialist for our St. Paul, MN territory. We offer an excellent compensation package and comprehensive benefits, including: competitive salary, 401K, Medical, Dental, Vision, Life Insurance and tuition reimbursement.
JOB SUMMARY:
Based on clinical experience, evaluates patient, payer, and diagnosis information to coordinate and review documentation for reimbursement. This position may also provide clinical management to coordinate all aspects of the Outcomes Monitoring Program for the Vest and works directly with patients and health care teams.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Clinical file review of documentation to determine whether medical records meet Medicare policy criteria for reimbursement.
Interview patients regarding medical history for justification of medical necessity of The Vest® according to Medicare guidelines.
Document file activity in the database as it occurs.
Communicate patient information to Field staff, when pertinent
Contact other medical professionals and gather additional documentation to support policy criteria or payer strategy.
Work with internal departments to strategize appropriate process changes in supporting Medicare Clinical Review and Medicare Appeals.
Assess cases, develop strategies and set-timelines to ensure deadlines are met.
Identify appropriate resolution for files if denied by Medicare.
Initiate the pick-up process ,when necessary
Other duties or projects as assigned.
