Reauthorization Specialist

VieMed Careers•Lafayette, LA

About The Position

This role is responsible for reviewing and obtaining necessary compliant documentation, medical records, and prescriptions to submit for prior authorization with insurance. The specialist will obtain prior authorization from insurance payors for durable medical equipment, verify patient demographic and health insurance information, and review pending tasks daily for authorizations and/or appeals. The position also involves notifying RT/Sales management teams about non-compliance and missed authorization deadlines, establishing and maintaining effective communication with patients/families, physician offices, and internal teams, and performing various clerical tasks such as answering calls, faxing, and emailing. The specialist will communicate appropriately and clearly to management and report all concerns or issues directly to the Revenue Cycle Manager and Supervisor. Other responsibilities and projects may be assigned.

Requirements

High School Diploma or equivalent.
Learn and maintain knowledge of current patient database and billing system.
Verify 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.
Sufficient knowledge of policies and procedures to accurately answer questions from internal and external customers.
Utilize initiative while maintaining set levels of productivity with consistent accuracy.
Minimum of 1 year of insurance verification or authorizations required.
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 for prior authorization.
Obtain prior authorization from insurance payor for durable medical equipment.
Verify patient demographic and health insurance information.
Review and work pending tasks daily for authorizations and/or appeals.
Notify RT/Sales management teams regarding non-compliance and authorization deadlines.
Establish and maintain effective communication with patients/family, physicians’ offices, and other internal teams.
Perform clerical tasks such as answering patient/Insurance calls, faxing, and emailing.
Communicate appropriately and clearly to Manager/Supervisor, and other superiors.
Report all concerns or issues directly to Revenue Cycle Manager and Supervisor.
Undertake other responsibilities and projects as assigned.