Our CMN Representative is responsible for monitoring Certificate of Medical Necessity (CMN) and prescription activity in a timely manner. Key responsibilities include the prompt submission of CMNs, consistent follow-up and tracking, staying current with coverage criteria changes, and providing timely responses to referral sources and internal staff.

Education:

• High school diploma or equivalent required.

Licensure/Certification/Registry:

• Must possess a valid Illinois driver’s license and meet the requirements of the MHS Fleet Safety Policy.

• Must have access to a personal vehicle with current proof of insurance.

Experience:

• A minimum of one year of medical experience is preferred.

• Working knowledge of medical equipment and medical terminology is highly desirable.

Other Knowledge/Skills/Abilities:

• Basic to intermediate computer skills, including proficiency in Microsoft Office (Word, Excel, and Outlook), are required.

• Must be thorough and detail-oriented, with strong decision-making, communication, and interpersonal skills.

• Ability to build positive relationships with physician office staff.

• Must be able to multitask effectively, work independently, and consistently achieve goals related to CMN receipt processing.

• Retrieve access and print Certificates of Medical Necessity (CMNs) from the billing software. Prepare and forward CMNs to attending physicians for timely completion and signature.

• Document and monitor both paper and electronic systems to ensure proper issuance of clinical orders and CMNs, avoiding duplication or oversight.

• Verify clinical orders against Medicare, Medicaid, and other third-party insurance billing requirements. Secure or issue additional documentation as needed to meet payer guidelines.

• Use “tickler” files and system-generated reports to track the timely return of clinical orders and CMNs. Reissue duplicates and follow up with physician offices via phone or in person, as necessary.

• Receive, sort, and distribute completed and approved CMNs. Accurately log and maintain customer data in the billing software system.

• Communicate with physician offices—via mail, phone, fax, or in person—to resolve incomplete or incorrect CMNs.

• Regularly review and monitor the unbilled CMN report to ensure all outstanding items are resolved within pre-approved timelines.

• Provide feedback and suggestions to the marketing team to improve CMN processes and enhance documentation workflows with physician offices.

• Perform other related duties as required or assigned.