Qualification Specialist

Norco, Inc.•Meridian, ID

12d

About The Position

Norco is currently seeking an individual to fill our Qualification Specialist Position. The Qualification Specialist ensures that medical documentation is accurate and gathered in an efficient and timely manner for all orders. Other responsibilities include, but are not limited to:

Requirements

High school graduate or equivalent
Accurately enter data into computer and acquire a working knowledge or any software applications applicable to the position
Complete understanding of medical software used by Norco (on the job training)
Perform basic mathematics calculations
Perform tasks requiring manual dexterity (i.e processing paperwork, filing, stapling, sorting, etc.)
Excellent problem solving skills
Excellent verbal and written communication skills

Responsibilities

Have knowledge of the documentation requirements for the payers and product categories for which Norco provides services
Have knowledge of insurance company policy manuals, fee schedules, and contracts
Perform Insurance Verification
Gather medical documentation required to meet specific insurance company's guidelines
Submit and obtain insurance prior authorizations via fax, online portal entry, mail, etc for equipment prior to delivery whenever possible
Review documentation to assure pay coverage criteria is met when a prior authorization cannot be obtained from the insurance company
Follow up with therapists and physicians when DWOs, DPDs, chart notes, and LMNs are not received per Norco protocol
Stay abreast of industry updates and Medicare changes
Perform other tasks as assigned or necessary