Prior Authorization Specialist

Job Description

We have an exciting opportunity for you to join our team as a Prior Authorization Specialist in the Strongsville, Ohio Area. In this position, you will play a vital role in ensuring the success of our wheelchair production at NPL. As a member of our team, you will have an opportunity for personal and professional growth and career advancement as we build on our consecutive years of significant growth. We are also proud to have been recognized for our amazing workplace and culture, including being selected as one of the:

• Best Employers in Ohio by Crain’s Magazine for the last 5 consecutive years
• Top Employers in Cleveland by Cleveland.com for the last 4 consecutive years
• Top Workplace’s in NE Ohio by North Coast 99 for the last 4 consecutive years
• Crain’s Fast 50 – one of the 50 fastest growing businesses in Northeast Ohio over the last 5 years

Do not miss this opportunity to find career success with a forward thinking, entrepreneurial, and growing company.

Summary:

The NPL Prior Authorization Specialist will report to the Prior Authorization Department Manager. This individual is chartered with compiling all the necessary documentation required by insurance companies so they can authorize NPL to procure the material necessary to create the custom wheelchair solution for our customers/patients. This involves working with the sales team to ensure all required data has been collected and using NPL’s prescribed workflows, software, and conventions. The ideal candidate is experienced with the general requirements insurance companies use to determine patient eligibility for custom wheelchairs, long term care facility operations, patient physical therapy and mobility needs

While this role can be undertaken remotely, the successful candidate will be expected to attend company functions, meetings, and trainings from time to time at our Strongsville, Ohio facility.

Main Responsibilities:

• Ensures timely and accurate insurance authorizations are in place prior to services being rendered or products being ordered.
• Captures insurance requirements per equipment class and provides guidance to staff.
• Checks all Prior Authorization material for accuracy prior to submitting to Prior Authorization / Approval Specialist
• Creates prescribed prior authorization packets of insurance documents that will be used as part of the electronic submission to the insurance company.
• Assists with uploading prior authorization packets into insurance company portals.
• As prescribed, checks insurance company portals to check the status of previous submissions.
• Continues to improve our workflow process to save time and money.
• Assist with incoming Company phone calls.
• Assist with service prior authorization process.
• Collects additional information should the insurance companies require it.
• Follows the appropriate NPL process once approved by the insurance company, including verifying approval to what was submitted, loading approval information into NPL’s workflow software, updating spreadsheet/workflow, and notifying the appropriate sales representative the chair was approved.
• Identifies trends relating to any prior authorization changes at the insurance companies that could require an NPL process change and bringing to the attention of management.

Qualifications and Experience:

• High School certificate or GED.
• Strong attention to details and organization skills.
• Ability to gather required information and while working through NPL’s workflows.
• Knowledge of health insurance and/or reimbursements.
• Excellent data analysis skills.
• Computer savvy.
• Experience in a Medical products or service business a strong plus.

NPL Home Medical is an Equal Opportunity Employer. NPL Home Medical does not discriminate against any person on the basis of gender, race, color, national origin, religion, disability, age, veteran status, gender identity or sexual orientation in admission, treatment, or participation in its programs, services and activities, or in employment, or on the basis of gender in its health programs and activities.

Job Type: Full-time

Job Type: Full-time

Pay: $40,000.00 - $45,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible schedule
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Professional development assistance
• Referral program
• Retirement plan
• Tuition reimbursement
• Vision insurance
• Wellness program

Ability to Commute:

• Strongsville, OH 44149 (Required)

Work Location: Hybrid remote in Strongsville, OH 44149

Salary : $40,000 - $45,000