• Assist client in identifying, validating, and recovering claim overpayments. • Validate claims to ensure the accuracy of algorithms and that no refund has previously been posted to the client’s system(s). • Review and resolve disputed overpayments from client/provider. • Participate in knowledge sharing to brainstorm and resolve claim issues or seek clarifications. • Identify new overpayment opportunities and trends by reviewing and researching areas such as CMS and Medicaid claims processing policies, adjustments by client’s internal unit/other vendors, client’s claims processing policies/system(s), provider, and member contracts. • Interpret and analyze medical and pharmacy claims data as well as provider and enrollment data to accurately assess and demonstrate key insights into trends and opportunities and follow concept development process. • Assist Management with concept approval information needed for client approval on specific trends. • Complete step by step instructions for each algorithm moved to production. • Always represent TREND and our clients in a professional manner. • Cooperate with team members to meet goals and complete tasks in an efficient and effective manner. • Provide feedback to Management regarding inventory levels, algorithm effectiveness/productivity, and new trend/ideas. • Collaborate with TREND Management to identify new opportunities, areas of improvement, and innovate potential solutions. • Escalate to the manager any situation outside the employee’s control that could adversely impact the business relationship. • Train and assist new analysts as needed while maintaining high quality and production results. • Assist with Quality Review process. • Ensure staff is appropriately resolving day-to-day problems in a timely and successful manner

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Coordinates with the Funding Manager, Funding Supervisor, Branch Manager, Rehabilitation Technology Supplier (RTS), and other office support personnel to ensure all operational procedures are completed in accordance with company policy and within expected time frames. Responsible for correcting and reworking any order that is unable to be billed or has resulted in a claim denial due to missing or incorrect information. This can include: - Coding & Pricing - Gathering information and documents pertinent to the funding package - Ensuring that all documentation is in place - Submission to the funding sources - Collecting payer decisions including authorizations, denials, and deferrals Qualifications - Minimum of 3 years of experience related to Durable Medical Equipment and/or Complex Rehab Technology - Preferred experience in all aspects of a Funding Specialist’s position including processing both Repairs and Non-Repairs - Extensive knowledge of the process and insurance guidelines to secure funding for Durable Medical Equipment and/or Complex Rehab Technology - Comprehensive knowledge of insurance verification for DME - Proficient in Microsoft Excel, Word, and Outlook - Strong ability to problem solve - Knowledge of NSM P&P and ability to interpret and follow payer guidelines and all Policies and Procedures Requirements - Responsible for problem-solving, correcting, and reworking any order that is unable to be billed or has resulted in a claim denial due to missing or incorrect information - Ensures the accuracy of and completes updates to all required coding, modifiers, and pricing - Verifies client benefits and coverage and communicates benefit information to client - Gathers and reviews documentation for payer, including but not limited to: - Proper prescriptions - Letters of Medical Necessity (LMN) - RTS evaluation information - Price lists - Forms (AOB, ABN, rent or purchase letter) - Communicates regularly with Physicians, Therapists, RTSs, and Clients to secure documentation as required by payer - Communicates changes and escalations in the process and collects needed information from branch personnel, Referral sources, Physicians, Therapists, RTSs, and Clients - Investigates and updates any payer requirements - Maintains communication with client throughout the process when applicable, including notifying them of financial responsibility - Coordinates with branch staff to secure pick up and redelivery documentation as required - When appropriate, discusses and secures approvals to write off or adjust balances - Communicates with Billing and Collection team to ensure that timely filing deadlines are met and/or to resolve any clarification on MIRs - Properly noting and closing MIRs with a complete and thorough response through the Funding Portal and Mobility Advisor - Performs any related job duties assigned by the MIR Manager, carrying out all position expectations in a professional manner and with minimal supervision - Responsible to complete all continuing education requirements to include assigned NSM University courses - Must maintain regular and predictable attendance Work Environment This position primarily operates in a work from home environment. The work from home policy and requirements must be adhered to. Occasionally, this job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, printers, photocopiers, filing cabinets, and fax machines. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to: - Talk or hear - Sit - Use hands repetitively to operate standard office equipment - Reach with hands and arms Benefits - 401k - Company paid Long Term Disability - Tuition reimbursement Company Description At all levels, working at National Seating & Mobility provides the opportunity to directly impact our client’s lives by giving them self-reliance and independence. Our teams are comprised of passionate individuals, dedicated to providing the best care to each client. We focus on abilities by leveraging technology and creating mobility solutions that are as unique as our client’s needs. Working at National Seating & Mobility is an opportunity to build a meaningful career while leaving a lasting impact on the lives of those we serve. Located in more than 40 states, we strive for diversity.

• Investigate and document claims involving liability exposures and litigation proceedings, • Conduct detailed policy/coverage reviews, take recorded statements, assign inspections, actively manage reserves, prepare or review damages and injuries, hire coverage and defense counsel, and negotiate settlements on high severity or complex losses. • Communicate claim updates and decisions verbally and in writing • Handle claims in compliance with all applicable regulations and internal processes • Provide technical expertise and serve as an SME for Claims-related projects • Act as a resource for less experienced staff • Support catastrophe response as needed, to include potential overtime • Any other duties needed to help drive our purpose and fulfill our values

• Conduct thorough investigations into bodily injury claims, including reviewing medical records, police reports, and witness statements. • Evaluate the extent of injuries and determine liability based on policy coverage, state regulations, and legal precedents. • Communicate with claimants, attorneys, medical providers, and other parties to gather necessary information and documentation. • Analyze medical reports and bills to assess the nature and severity of injuries and determine appropriate compensation. • Negotiate settlements with claimants and their representatives in accordance with company policies and regulatory requirements. • Collaborate with internal parties, legal counsel, and management, to resolve complex claims and mitigate risk. • Maintain accurate and detailed claim files, documentation, and activity logs in accordance with company standards and industry best practices. • Stay informed about changes in laws, regulations, and industry trends related to bodily injury claims management.