HME Authorization Specialist

Giving Home Health Care•Austin, TX

1d•Onsite

About The Position

The HME Specialist will serve as a critical member of the Giving Home Medical Equipment patient service team, specializing in the Prior Authorization Management. As part of the HME Operations Team which compiles, submits, and manages all Prior Authorization requests to the Dept of Labor.

Requirements

High school diploma or GED required
Excellent communication and customer service skills.
Strong and kind phone presence.
Detail-oriented with strong organizational abilities.
Brightree Experience
Salesforce experience.
Strong time management skills.
Background check, fingerprinting and TB test required

Nice To Haves

Associate’s or Bachelor’s degree in a healthcare-related field preferred.
Minimum 3 years of experience in a DME business environment perferred.
Familiarity with DOL, DEEOIC, and private insurance billing processes is a plus.
Deep and instinctual understanding of Durable Medical Equipment and Home Medical Equipment. Its use, functions, and care.

Responsibilities

Coordinate with internal Giving Home Medical Equipment, Home Health Care, and external referral sources to collect and verify patient information and medical documentation.
Manage Document transfers from software platforms to organize patient documents appropriately.
Communicate with internal and external team members when necessary for retrieval of documentation from physician offices.
Scanning of mailed responses from Payors into Brightree and Salesforce systems.
Verify appropriate coding, cost, frequency and duration of requested Medical Equipment using Brightree.
Compile Prior Authorization packets and submit them through Payor Portals.
Manage Payor Portal Authorization updates and communicate these updates to team members.
Update Patient Records appropriately based on Authorization responses.
Update Salesforce and Brightree appropriately based on Authorization responses to direct actions to team members.
Monitor Authorization steps taken to ensure timeliness and compliance.
Complete tasks and Authorization requests promptly and within allowable timelines.
Place calls to DOL Medical Benefits Examiners to determine the reasoning behind Authorization processing decisions.
Receive calls from DOL Medical Benefits Examiners regarding questions for submitted Authorization Requests.
Communicate effectively and professionally with Payor representatives to ensure appropriate processing of Authorization Requests.
Assist HME Operations with the monitoring and working of reports to facilitate Prior Authorization needs.
Collaborate with Billing Departments for Pricing/Fee Schedule Updates.
Collaborate with HME and Home Health departments as necessary.
Communicate with patients/care team members/DOL via inbound and outbound phone calls.
Act as a liaison between patients, Home Health teams, clinicians, and payers to ensure seamless communication and service delivery.
Assist Giving HME as a whole by performing additional duties and responsibilities as necessary to provide the best care possible for patients.