Authorization Specialist

Reliable Respiratory•Denver, CO

22h•Onsite

About The Position

Reliable Respiratory is a Durable Medical Equipment (DME) company providing services and equipment for patients who need respiratory, diabetes, urology, and maternity support. The Authorization Specialist reviews active rentals and future claims to ensure required documentation, prior authorization, and patient eligibility are in place for successful claim payment. The role also provides service to patients and their families, payors, providers, and team members. This is a full-time position based in Reliable Respiratory’s Denver, Colorado office. The role operates in a professional office environment, where the noise level is usually moderate to loud, and routinely uses standard office equipment.

Requirements

Be at least 18 years of age.
Be eligible to work in the United States and not require work authorization from the employer now or in the future.
Have an associate’s degree or two years of relevant authorization, claims, or billing experience.
Demonstrate effective problem-solving skills.
Listen attentively to others’ ideas and concerns.
Make timely decisions when options are clear and pressure or risk is low.
Maintain composure through unexpected circumstances.
Take initiative without being asked or required.
Exercise excellent judgment in executing job duties.
Have effective, professional verbal and written communication abilities.
Seek to improve work performance.
Respond to internal and external inquiries in a timely manner.
Demonstrate excellent customer service, particularly in high-intensity situations.
Have strong attention to detail.
Be proficient with computer applications, especially Microsoft Office Suite.
Be able to work independently and collaboratively.
Be able to prioritize and complete work amid interruptions in a busy work area.
Be able to comply with internal and industry-imposed guidelines and regulations.

Responsibilities

Provide exceptional service to patients, families, payors, providers, and team members.
Meet or exceed annual performance indicators set by organizational leadership.
Complete assigned tasks and worklists in a timely manner.
Ensure scheduled equipment-rental service dates are billed on time and correctly.
Ensure supply orders can be placed and delivered when patients are eligible for new supplies.
Work with providers and patients to obtain necessary and current medical documentation.
Stay current on insurance guidelines and authorization and billing requirements.
Keep patient charts up to date and accurate.
Update patient insurance policies and adjust sales orders as needed.
Perform basic billing tasks, including credit adjustments and recalculation of billing service dates to ensure sales orders bill correctly.
Verify patient insurance eligibility, including contacting payors to investigate and confirm policy terms, benefits, and costs.
Facilitate prior-authorization requests for commercial, Medicaid, and Medicare policies.
Help providers and patients understand payor coverage requirements, including authorization, compliance, and appeals for denied services or claims.
Process payment for services rendered.
Evaluate or escalate patient accounts that do not meet insurance or provider guidelines.
Troubleshoot equipment issues with patients and refer issues to the Reliable clinical team, manufacturers’ care teams, or referring providers as appropriate.
Verify equipment scheduled to be returned or picked up to ensure appropriate billing to the patient or insurance.
Participate actively in meetings as necessary.
Perform other duties and special projects as assigned and directed.