Authorization and Appeals Specialist

Key Responsibilities

• Patient Intake: Receiving and processing new patient referrals, gathering necessary demographic, medical, and insurance information. This will require outbound and inbound professional communications, interface with BPO partners and quality control measures.
• Insurance Verification: Verifying patient insurance coverage and benefits for BioTAB products, update cases accordingly for record keeping and internal Insurance Database. Verify patient benefits with insurance companies and manage utilization review activities, requests and obtain prior authorizations from insurance providers to ensure the equipment is covered.
• Clinical Coordination: Collaborating with sales, patients and their caregivers / healthcare professionals to get the patient’s products covered, shipped and in use, with quality and accuracy at the forefront of every case processed. Provide administrative support as needed, including assistance with documentation, communication, and clerical tasks.
• Process Management: Answer incoming calls to services lines and provide patient support, answer questions and document interactions & resolutions in CRM. Escalate any urgent requests & direct to correct departments or Leaders.
• Communication: Maintain clear and effective communication with patients, families, and other healthcare team members. Provide strong customer service, responding quickly and appropriately to patient needs, and can manage potentially difficult or emotional situations.
• Record Management: Ensuring accurate and timely documentation of all case activities and patient information in the required system. Maintain accurate and organized records of client interactions, service plans, and case management activities. Create and manage electronic consent forms; upload signed forms to patient charts. Complete forms, produce reports on client progress and service delivery, and ensure compliance with organizational policies and regulatory requirements.

Job Requirements & Physical Demands

• Must be able to lift 40 pounds, must be able to lift 40 pounds from the floor and lift to waist level.
• Must be able to kneel, stoop, climb stairs and reach with hands and arms.
• Reliable work transportation.
• Candidates must pass an extensive background check.
• Strict adherence to HIPAA, Medicare Fraud, Waste, and Abuse and privacy regulations in all patient interactions.