What are the responsibilities and job description for the Reauthorization Specialist position at VieMed Healthcare?
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.
- 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.
- 2-4 Years in DME or Medical Office experience preferred.
- Minimum of 1 year of insurance verification or authorizations required.
- Superior organizational skills.
- Proficient in Microsoft Office, including Outlook, Word, and Excel.
- Attention to detail and accuracy.