Reauthorization Specialist

­­­­­­­­­­­­­­­­­­­ Duties:

• Review and obtain necessary compliant documentation, medical records and prescriptions in order to submit for prior authorization with insurance.

• Responsible for obtaining prior authorization from insurance payor for durable medical equipment.

• Verifies 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

• Establishes and maintains effective communication and good working relationships with patients/family, physicians’ offices, and other internal teams for the patient’s benefit.

• Performs other clerical tasks as needed, such as

• Answering patient/Insurance calls

• Faxing and Emails

• Communicates appropriately and clearly to Manager/Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor

• Other responsibilities and projects as assigned.

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.

Experience:

• 2-4 Years in DME or Medical Office experience preferred.
• Minimum of 1 year of insurance verification or authorizations required.

Skills:

• Superior organizational skills.
• Proficient in Microsoft Office, including Outlook, Word, and Excel.
• Attention to detail and accuracy.

Effective/professional communication skills (written and oral)