Requalification Specialist

Location: Tarentum, PA

Department: Claims Department

At Blackburn’s, our mission is simple: put people first, our patients, our employees, and our community. We are seeking a detail-driven Requalification Specialist to join our Claims Department and help ensure timely, accurate, and compliant requalification processes for our patients and insurance partners.

Position Summary

The Requalification Specialist plays a vital role in managing documentation, authorizations, and prescription renewals to keep patient services uninterrupted and compliant with insurance requirements. This position requires strong attention to detail, excellent communication skills, and the ability to work efficiently in a fast-paced environment.

Key Responsibilities

• Perform all duties in a timely manner with strict attention to insurance filing deadlines.
• Demonstrate an in-depth understanding of documentation and authorization requirements for various insurance plans.
• Create, send, monitor, verify, and log documentation and authorizations promptly to prevent write-offs.
• Understand and apply medical necessity criteria for insurance authorizations.
• Use computer reports to prioritize follow-up for documentation and re-authorizations.
• Renew prescriptions with consistent and timely follow-up to ensure uninterrupted patient compliance and prevent delays in the requalification process.
• Communicate any issues or emerging trends impacting the requalification process with the department manager.
• Suggest process improvements to reduce denials and increase operational efficiency.
• Perform additional duties or project work as assigned and approved by management.

Qualifications

• Highly detail-oriented, organized, and goal-driven.
• Strong written and verbal communication skills.
• Excellent interpersonal skills with the ability to work collaboratively across teams.
• Effective time-management skills with the ability to prioritize and manage multiple tasks.
• Proficient computer skills required.
• Experience in a healthcare-related field and knowledge of medical third-party billing preferred.
• Familiarity with Microsoft Word and Excel is helpful.

Why Join Blackburn’s?

• Meaningful impact: Your work directly supports patients in receiving essential, life-changing equipment and services.
• Collaborative culture: Join a supportive team that values communication, respect, and shared success.
• Professional growth: Access opportunities for ongoing training, skill development, and career advancement.
• Dynamic environment: Enjoy a mission-driven workplace where every day brings new challenges and opportunities to make a difference.

At Blackburn’s, you’ll do more than coordinate care, you’ll help transform lives.