Reauthorization Specialist

­­­­­­­­­­­­­­­­­­­ Duties:

1. Review and obtain necessary compliant documentation, medical records and prescriptions in order to submit for prior authorization with insurance.
2. Responsible for obtaining prior authorization from insurance payor for durable medical equipment.
3. Verifies patient demographic and health insurance information to review & work pending task daily for authorizations &/or appeals
4. Notify RT/Sales management teams regarding non-compliance and authorization deadlines that are not met
5. Establishes and maintains effective communication and good working relationships with patients/family, physicians’ offices, and other internal teams for the patient’s benefit.
6. Performs other clerical tasks as needed, such as
   • Answering patient/Insurance calls
   • Faxing and Emails
7. Communicates appropriately and clearly to Manager/Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor
8. 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)