Authorization and Appeals Specialist

BioTAB Healthcare•St. Louis, MO

3d•Onsite

About The Position

For more than 20 years, BioTAB Healthcare, LLC has supported patients with lymphatic, wound, and circulatory disorders through proven treatment solutions. Headquartered in Missouri, we provide pneumatic compression devices and personalized service to help improve patient outcomes and quality of life. As a family-owned company, we take pride in delivering expert care with a personal touch service. The Patient Services Representative position puts the Patient First in every interaction. This role will process clinical paperwork from our sales team, review coverage requirements under private health insurance, CMS and research patient benefits to obtain product approvals in order to process the patient’s orders. This role will interface with patients, sales, sales leadership, clinicians and our internal teams on a daily basis, and will include both incoming and outgoing calls, emails, CRM and Provider systems, fax, email and Vendor portals. Reps will handle all documentation requirements for patient charting, shipping and cost to make the patient experience as smooth as possible. This role, reporting to the team’s Managers and Directors, will require an exceptional level of detail, customer service acumen and an emphasis on process execution and quality control.

Requirements

Strong communication and interpersonal skills: To interact effectively with patients, families, and healthcare professionals.
Ability to work independently and as a team member, take direction and participate in Continuous Education as required for the role.
Excellent organizational and time management skills: To manage a high volume of tasks and ensure timely processing of information.
Attention to detail: To ensure accuracy in patient records and insurance information.
Ability to multitask and prioritize duties to support delivery of high-quality patient experience.
Knowledge of healthcare regulations and insurance processes: To navigate the complexities of DME care.
Problem-solving skills: To address any issues or challenges that may arise during the work process.
High School or equivalent required.
Must be able to use SalesForce or Epic, fax, email, GSuite or Office, in/outbound calls with appropriate grammar, spelling and punctuation.
Strong communication skills, both written and verbal.
Comfortable handling sensitive and confidential Information (HIPAA).
Must be able to lift 40 pounds, must be able to lift 40 pounds from the floor and lift to waist level.
Must be able to kneel, stoop, climb stairs and reach with hands and arms.
Reliable work transportation.
Candidates must pass an extensive background check.
Strict adherence to HIPAA, Medicare Fraud, Waste, and Abuse and privacy regulations in all patient interactions.

Nice To Haves

Associates/bachelor’s degree preferred.
1+ years of experience in healthcare operations, customer service, or similar role or setting preferred.

Responsibilities

Receiving and processing new patient referrals, gathering necessary demographic, medical, and insurance information, requiring outbound and inbound professional communications, interface with BPO partners and quality control measures.
Verifying patient insurance coverage and benefits for BioTAB products, updating cases accordingly for record keeping and internal Insurance Database.
Verifying patient benefits with insurance companies and managing utilization review activities, requests and obtaining prior authorizations from insurance providers to ensure the equipment is covered.
Collaborating with sales, patients and their caregivers / healthcare professionals to get the patient’s products covered, shipped and in use, with quality and accuracy at the forefront of every case processed.
Providing administrative support as needed, including assistance with documentation, communication, and clerical tasks.
Answering incoming calls to services lines and providing patient support, answering questions and documenting interactions & resolutions in CRM.
Escalating any urgent requests & directing to correct departments or Leaders.
Maintaining clear and effective communication with patients, families, and other healthcare team members.
Providing strong customer service, responding quickly and appropriately to patient needs, and managing potentially difficult or emotional situations.
Ensuring accurate and timely documentation of all case activities and patient information in the required system.
Maintaining accurate and organized records of client interactions, service plans, and case management activities.
Creating and managing electronic consent forms; uploading signed forms to patient charts.
Completing forms, producing reports on client progress and service delivery, and ensuring compliance with organizational policies and regulatory requirements.
Ensuring compliance with relevant healthcare regulations, financial standards, and internal policies.
Preparing cases and escalations for Review and other regulatory agencies, assisting in monitoring compliance with Medicare regulations.
Adhering to all relevant regulations and agency policies regarding patient intake and data management, including but not limited to: CMS and OFCCP guidelines related to our Quality Management System, documentation and process creation and training.
Benefits & prior-authorizations
Appeals
Re-certifications
Interface with Parachute
Case review & processing documentation
Order review & confirmation
Re-work
Interface with TMs, Bonafide, calls