Reauthorization Specialist

VieMed Healthcare • Lafayette, LA

4d

About The Position

This role is responsible for obtaining prior authorization from insurance payors for durable medical equipment. The specialist will review and obtain necessary compliant documentation, medical records, and prescriptions to submit for prior authorization. They will also verify patient demographic and health insurance information, work pending tasks daily for authorizations and/or appeals, and communicate non-compliance and authorization deadlines to relevant teams. Effective communication with patients, physicians' offices, and internal teams is crucial for the patient's benefit. The role also involves performing clerical tasks such as answering calls, faxing, and emailing, and reporting concerns to management.

Requirements

• High School Diploma or equivalent.
• Learns and maintains knowledge of current patient database and billing system.
• Verifying Insurance for all products.
• Understand Insurance benefit breakdown of deductibles and co-ins.
• Understand Insurance Medical and Payment Policies.
• Knowledge of Explanation of Benefits from insurance companies.
• General knowledge of government, regulatory billing and compliance regulations/policies for Medicare & Medicaid.
• Working knowledge of CPT and ICD-10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits.
• Enough knowledge of policies and procedures to accurately answer questions from internal and external customers.
• Utilizes initiative while maintaining set levels of productivity with consistent accuracy.
• Superior organizational skills.
• Proficient in Microsoft Office, including Outlook, Word, and Excel.
• Attention to detail and accuracy.
• Effective/professional communication skills (written and oral).

Nice To Haves

• 2-4 Years in DME or Medical Office experience preferred.

Responsibilities

• Review and obtain necessary compliant documentation, medical records and prescriptions in order to submit for prior authorization with insurance.
• Obtain prior authorization from insurance payor for durable medical equipment.
• Verify patient demographic and health insurance information to review & work pending task daily for authorizations &/or appeals.
• Notify RT/Sales management teams regarding non-compliance and authorization deadlines that are not met.
• Establish and maintain effective communication and good working relationships with patients/family, physicians’ offices, and other internal teams for the patient’s benefit.
• Perform other clerical tasks as needed, such as Answering patient/Insurance calls, Faxing and Emails.
• Communicate appropriately and clearly to Manager/Supervisor, and other superiors. Report all concerns or issues directly to Revenue Cycle Manager and Supervisor.
• Other responsibilities and projects as assigned.

What This Job Offers

• Career Level: Entry Level
• Education Level: High school or GED