Authorization & Benefits Specialist
About The Position
The Authorization & Benefits (A&B) Specialist is responsible for submitting and monitoring continuation-of-care authorizations, as well as obtaining new authorizations when insurance changes occur for existing patients ensuring uninterrupted SmartVest therapy and preventing delays in billing. The A&B Specialist serves as a liaison between patients, healthcare providers, and insurance companies by verifying benefits, submitting timely re-certification requests, and efficiently managing both approval and denial outcomes. Excellent communication skills and exceptional attention to detail are critical for success in this role. This is a full-time, remote position.
Requirements
- High School diploma or GED required; degree preferred
- Experience working with insurance companies in the capacity of benefits, coverage, and authorizations
- Experience working directly with third party or government payers
- Experience with medical terminology
- Knowledgeable of insurance requirements and can determine medical justification to ensure proper reimbursement
- Knowledge of Microsoft Office suite
- High attention to detail and accuracy with the ability to handle multiple priorities
- Self-starter, motivated, team-player
- Excellent written and verbal communication skills
- Demonstrated exceptional customer service skills
- Ability to prioritize and organize
- Strong analytical and problem-solving skills
- Active participant of continuous improvement
Responsibilities
- Follow Electromed mission and core values, while striving to achieve company goals
- Understand and adhere to local State and Federal healthcare regulatory and compliance rules
- Review documentation for updated patient demographics, insurance information, prescription requirements, and medical records per payer guidelines
- Verify insurance eligibility and DME benefits
- Comprehensively navigate payer websites
- Competently communicate with payers, clinics, PCP’s
- Effectively submit insurance requests to obtain authorization(s) and referrals
- Communicate effectively with Reimbursement Team, such as Patient Account Liaisons and Patient Services
- Educate patients on complex reimbursement situations
- Accurately record information to internal Patient Database
- Complete other miscellaneous tasks as needed to help support the reimbursement team
- Handle denied recertifications in a timely manner by obtaining needed documentation and forwarding to the Appeals Team
Benefits
- 6 weeks’ time off annually
- Employee bonus plan
- Flexible hybrid/remote work options
- Full pay maternity, paternity, parental, short-term disability leaves
- Employee driven recognition program
- Access to hundreds of training opportunities
- Company paid educational assistance
- Well-being on demand
- Perks at Work
- Competitive health and welfare plans -HSA company contribution
- 401(k) company match
- Great culture and people!
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
51-100 employees
