Prior Authorization

Job Summary

We are seeking a highly organized, detail-oriented, and customer-focused Prior Authorization & Ordering Specialist to join our Ordering Team.

In this roll you will be responsible for managing authorization requests specific to the DEEOIC program. This role requires excellent communication, research, and writing skills. Additionally, you will be responsible for providing expert guidance to customers and healthcare professionals regarding our medical equipment offerings, ensuring that our clients receive the best solutions for their needs.

Key Responsibilities:

• Serve as the primary point of contact for patients, providers, and case managers regarding DME products and authorization status

• Provide expert guidance on DME offerings, including mobility aids and respiratory equipment

• Assist customers in selecting appropriate equipment based on medical needs and prescriptions

• Process prior authorization requests in accordance with DOL DEEOIC guidelines

• Research medical conditions and write Letters of Medical Necessity (LMNs) and product justifications

• Communicate effectively with physicians, nurse case managers, and DOL claims examiners

• Track authorization statuses, follow up on pending cases, and prepare appeals as needed

• Coordinate equipment ordering, delivery, and setup to ensure a seamless patient experience

• Resolve customer concerns and troubleshoot equipment issues

• Maintain compliance with HIPAA and DOL regulations, as well as internal policies

Qualifications:

• High school diploma or equivalent

• Excellent customer service skills with the ability to communicate complex medical information clearly and effectively

• Problem-solving skills

• Ability to work both independently and as part of a team

• Proficiency in Microsoft Office and Google applications

• Strong attention to detail and ability to multitask in a fast-paced environment.

Benefits:

• Paid training

• Paid time off and holidays

• Company-sponsored wellness program

• Supportive team environment with opportunities to grow