Durable Medical Equipment Clerk

Description

Under the direct supervision of the DME Department Leadership, the DME Clerk is responsible for receiving, reviewing, and processing referrals for Durable Medical Equipment (DME), Orthotics, Prosthetics, and Mobility devices. This role involves coordinating with medical professionals, verifying benefits, ordering equipment from vendors, and ensuring compliance with regulatory and organizational guidelines. The DME Clerk plays a vital role in ensuring timely and accurate delivery of equipment and services to members while maintaining exceptional customer service standards.

Essential Functions:

• Receive, review, and processes referrals for DME, Orthotics, and Prosthetics based on clinical documentation and benefit criteria.


• Interpret and apply DME coverage guidelines, including the DME Formulary, Evidence of Coverage, and regulatory requirements.


• Verify member eligibility and benefits using internal systems (e.g., KP Health Connect, Foundation System, etc.).


• Order equipment and supplies from vendors using DME processing systems.


• Track and follow up on equipment renewals, denials, and purchases.


• Maintain accurate documentation and records of all transactions and communications.


• Serve as a liaison between physicians, medical staff, patients, families, and vendors.


• Answer incoming calls from members, KP Staff, and vendors regarding DME services.


• Participate in departmental quality assurance activities and assist in the orientation of new staff.


• Perform general administrative duties including data entry, faxing, mailing, and phone support.


• Process and resolve vendor escalations and request assistance as needed.


• Participate in DME-related projects and workgroups as assigned.


• Support problem resolution and escalate complex issues to appropriate Department Staff.


• Maintain and update knowledge of benefit administration tools and ordering systems.


• Uphold Kaiser Permanente’s policies, procedures, and compliance standards.

Grade: 5