Part Time 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.

Compliance

• Ensure compliance with relevant healthcare regulations, financial standards, and internal policies. Prepares cases and escalations for Review and other regulatory agencies, assisting in monitoring compliance with Medicare regulations. Adhere to all relevant regulations and agency policies regarding patient intake and data management, including but not limited to: CMS and OFCCP guidelines related to our Quality Management System, documentation and process creation and training.

Required Skills & Abilities

• High School or equivalent required, associates/bachelor’s degree preferred.
• 1+ years of experience in healthcare operations, customer service, or similar role or setting preferred.
• Must be able to use SalesForce or Epic, fax, email, GSuite or Office, in/outbound calls with appropriate grammar, spelling and punctuation.
• Strong communication skills, both written and verbal.
• Comfortable handling sensitive and confidential Information (HIPAA).