Authorization Specialist

Reliable Respiratory•South Windsor, CT

6h•Onsite

About The Position

Reliable Respiratory is a Durable Medical Equipment (DME) company that provides the highest quality level of service for patients in need of respiratory, diabetes, urology, and maternity support. Equipment provided includes, CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, CGM devices, insulin pumps, and breast pumps. The Authorization Specialist reviews all active rentals, and future claims, to ensure proper documentation, prior authorization, and patient eligibility are met to achieve successful payment of claims while providing exceptional service to our patients and their families, payors, providers and team members.

Requirements

18 years of age or older
Must be eligible to work in the United States and not require work authorization from us now or in the future
Associate’s degree required or 2 years of relevant (authorization, claims, billing) experience
Demonstrates effective problem solving.
Listens attentively to people’ ideas and concerns.
Makes decisions in a timely manner when the options are clear and there is little pressure or risk.
Maintains balance through unexpected circumstances.
Acts without being asked or required to do so.
Exercises excellent judgment in all aspects of the execution of job duties.
Effective and professional verbal and written communication abilities.
Seeks to improve in all aspects of work performance.
Responds to internal and external inquiries in a timely manner.
Excellent customer service skills; especially in high intensity situations.
Strong attention to detail.
Proficient in the use of computer applications (especially Microsoft Office Suite).
Ability to work independently.
Ability to work in collaboration with others.
Ability to prioritize and complete work amidst interruptions in a busy work area.
Ability to comply with internal and industry-imposed guidelines/regulations.

Responsibilities

Provide exceptional service every time.
Meet or exceed annual performance indicators as outlined by organizational leadership.
Complete assigned tasks and worklists in a timely manner.
Ensure scheduled dates of service for equipment rentals bill on time and correctly.
Ensure supply orders can be placed and delivered to the patients when eligible for new supplies.
Work with providers and patients to obtain necessary and current medical documentation.
Stay up to date on insurance guidelines and their authorization and billing requirements.
Ensure patient charts are up to date and accurate.
Update patient insurance policies and adjust sales orders as needed.
Perform basic billing functions including but not limited to credit adjustments and recalculation of billing dates of service to ensure sales orders bill correctly.
Verify patients’ insurance eligibility, including contacting payors to investigate and verify the terms and benefits of patients’ insurance policies and costs.
Facilitate process for requesting prior authorizations for Commercial, Medicaid, and Medicare Policies.
Work with providers and patients to help them understand requirements for payor coverage including but not limited to: Authorization and compliance requirements, Appeals for denied services / claims.
Process payment for services rendered.
Evaluate and/or escalate patient accounts that do not meet insurance or provider guidelines.
Troubleshoot equipment issues with patients. Refer issues to the Reliable clinical team, manufacturer’s care teams or referring provider as needed.
Verify equipment scheduled to be returned or picked up, to ensure appropriate billing to patient and/or insurance.
Actively participate in meetings as necessary.
Perform other duties and special projects as assigned and directed.