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CMN Representative

Tracking Code

2022-13306

Position Type

FULL-TIME

Job Location

Springfield, IL

Description

Overview

CMN Representative will monitor certificate of medical necessity and prescription activity in a timely manner.  Responsibilities include timely submission of CMN’s, follow-up tracking, staying current with coverage criteria changes and responding to referral sources and staff. 

Qualifications

Education:

  • Education equivalent to graduation from high school.

Licensure/Certification/Registry:

  • Must possess valid Illinois driver’s license and must be deemed as an acceptable driver in accordance with the MHS Fleet Safety Policy. Must have availability of personal vehicle with proof of insurance.

Experience:

  • Minimum of one year of medical experience, coupled with a sound working knowledge of medical equipment and medical terminology is preferred.

Other Knowledge/Skills/Abilities:

  • Basic to Intermediate computer skills and experience with Microsoft Office Software (Word, Excel and Outlook) required.
  • Thorough and detailed oriented, ability to make informed decisions and possess good communication and interpersonal skills along with the ability to relate well with physician’s staff.
  • Ability to multi-task well, works independently and achieves set goals for CMN receipts.

Responsibilities

  • From the billing software retrieve access and print CMNs. Prepare and forward CMNs to attending physicians for timely completion and signature.
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  • Documents and monitors paper and electronic systems regarding the issuance of clinical orders and CMNs to avoid duplication or oversight.
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  • Verifies and monitors clinical orders as compared to Medicare, Medicaid and other third party insurance billing requirements. As necessary, secures and/or issues the additional documentation needed by these insurer’s requirements.
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  • Monitors, via “tickler” files and computer generated reports the timely return of clinical orders and CMNs, issuing duplicate CMNs as needed. Follows up directly with the physicians’ office via phone or in person as needed.
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  • Receives, sorts, and distributes approved CMNs and logs/maintains data and other relevant customer information into the billing software system.
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  • Communicates with physician’s office, via mail, phone, fax and in person, to resolve CMNs that are returned incomplete.
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  • Reviews and monitors unbilled CMN report and ensures their proper disposition within pre-approved guidelines.
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  • Provides feedback and recommendation to marketing staff as to the CMN process improvement and documentation flow/communication with physician’s offices.
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  • Performs other related work as required or requested.
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    The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job.  Incumbents may be requested to perform tasks other than those specifically presented in this description.

     


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