Who We Are

Maxi-Med Healthcare is a leading supplier of durable medical equipment, specializing in incontinence products, diabetes management tools, and a wide range of medical supplies. Our goal is to provide quality products and exceptional customer service to patients, caregivers, and healthcare professionals throughout Simi Valley and beyond.

Our team of experts includes experienced professionals who are dedicated to helping our clients find the right solutions for their unique needs. We understand that each patient has specific requirements, and we strive to provide tailored solutions that can improve their quality of life and make a real difference.

Job Summary

We are currently seeking a motivated and experienced individual to join our team as a Prior Authorization Representative. In this role, you will be responsible for prescirption refills and coordinating and completing prior authorizations, while assisting office staff with phone. This will play a critical role in ensuring the satisfaction of our customers.

The ideal candidate will have strong interpersonal skill with a strong attention to detail, and will be able to work effectively both independently and as part of a team. They must be able to prioritize tasks, work efficiently under pressure, and have excellent communication skills.

Responsibilities

Responsibilities include but are not limited to the list below. A more specific list will be provided during training, depending on your position.

• Communicate with all insurance companies, patients and providers
• Provide excellent customer service when interacting with patients regarding medical claims and payments, including communicating with patients and family members
• Answer questions and handle complaints from clients regarding orders
• Make corrections as necessary to ensure timely payment and completeness of all claims
• Post payments in a timely manner
• Research and analyze patient account activity to maintain accuracy of patient account balances
• Maintain, input, and update the billing system to ensure accurate and timely monthly billing
• Verify and confirm proper coverage through eligibility and benefit verification
• Research and resolve discrepancies, denials, appeals, and insurance mail-backs
• Research and analyze patient account activity to maintain accuracy of patient account balances
• Attend staff meetings and additional training sessions as requested

If you are passionate about helping people and making a difference in their lives, and have the required qualifications and skills, we encourage you to apply for this exciting opportunity. We offer a competitive salary, benefits package, and a dynamic work environment that values teamwork, innovation, and excellence.

Key Qualifications

• Commitment to excellence and high standards
• Ability to operate multiple software applications
• Knowledge of basic medical terminology
• Ability to work effectively with Peers and with Management
• Ability to communicate clearly and effectively with patients and other staff
• Ability to work independently
• Ability to work with big amounts of data and make correct judgements
• Must speak either Armenian or Farsi

Good-To-Have’s:

• 1 year of related experience
• Knowledge of CPT and ICD10 codes
• Understanding of Explanation of Benefits (EOBs), eligibilities and authorizations
• Knowledge of insurance and claims submission
• Ability to review patient bills and correct any missing or inaccurate information
• Certification in either billing or coding
• Knowledge of how to use a billing software to prepare and transmit claims
• Ability to investigate and appeal claims that were denied

Education

• High school, GED, or equivalent diploma required
• Bachelor’s Degree in a related field is a plus

Job Type: Full-time

Experience:

• Relevant: 1 year (Preferred)
• Call Center: 1 year (Preferred)
• Customer Service: 1 year (Preferred)

Education:

• High school or equivalent (Preferred)

Work Location:

• One location

Schedule:

• Monday to Friday
• No Weekends

Job Type: Full-time

Pay: From $22.00 per hour

Benefits:

• Paid time off

Weekly day range:

• Monday to Friday
• No weekends

Work Location: In person