Reauthorization Specialist

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.
• Notifies 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.

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.