Reimbursement Authorization Specialist I

Key Responsibilities

• Obtain and maintain documentation required to initiate and sustain referrals.
• Contact healthcare providers, state agencies, payers, DME/pharmacies for clinical documents, eligibility, benefits, prior authorizations, single case agreements, and letters of agreement.
• Upload and maintain documents and required fields in Salesforce; ensure effective dates and records are current.
• Prioritize and process incoming requests per Revenue Cycle guidelines; manage Pre-Orders awaiting finalized SF cases and signed documents.
• Cookordinate with contracted DMEs and pharmacies to ensure patient access to products.
• Provide patient/family guidance on eligibility, benefits verification, and prior authorization processes.
• Communicate with registered dietitians, regional sales, and Medical Billing/Collections regarding open, unpaid, or rejected claims.
• Maintain medical records in compliance with HIPAA and adhere to SOPs, quality, and safety policies.
• Perform other duties as assigned.

Required Qualifications

• A high school diploma or equivalent (college degree preferred).
• Minimum 2 years? experience in medical billing, eligibility, authorizations, and payer interactions.
• Understanding of HCPCS and ICD-10 coding.
• Knowledge of third-party payer rules, contracts, and regulations.
• Proficiency with Microsoft Office (Excel, Word, Teams).
• Strong customer service, written and oral communication skills.
• Ability to multitask, prioritize, work independently, and collaborate across teams.
• Strong listening skills, attention to detail, and compassion for patient needs.
• Knowledge of HIPAA and commitment to information security.

Preferred

• Experience with Salesforce or an Order Management System (OMS).

Benefits

• Competitive pay and annual bonus opportunity
• 401(k) with company contributions
• Medical, dental, vision (effective day 1)
• Paid time off, company & floating holidays
• Paid parental leave, EAP, wellness programs and reimbursement
• Tuition reimbursement, career development
• Company-paid life & disability insurance
• Work flexibility and mental health/caregiving support

Working Conditions / Physical Requirements

• Primarily office-based in a controlled environment; occasional outdoor/employee-event duties.
• May require entry into manufacturing areas with PPE.
• Ability to sit =6 hours/day; stand/walk/bend/reach regularly.
• Ability to lift/carry up to 25 lbs occasionally; repetitive hand/arm use for computer tasks.