Reimbursement Authorization Specialist I

About the role

The Reimbursement Authorization Specialist I plays a crucial role in the Revenue Cycle Team at Ajinomoto Cambrooke. This position focuses on assisting patients with accessing Cambrooke medical foods and formulas through the referral process. Key responsibilities include interacting with healthcare professionals, state agencies, and payers to ensure optimal coverage for patients.

Responsibilities

• Contact healthcare professionals, state agencies, and payers for clinical documents, eligibility, benefits, prior authorization, single case agreements, letter of agreements, and other items to ensure payment.
• Upload current documents and populate required fields in Salesforce.
• Maintain and update documents to ensure effective dates are always current.
• Work and respond to incoming requests timely, following Revenue Cycle Department guidelines.
• Coordinate with contracted Durable Medical Equipment companies and pharmacies to ensure patients and their families can obtain the required medical foods.
• Provide assistance and guidance for patients and their families during the eligibility, benefit verification, and prior authorization processes.
• Communicate and collaborate with registered dietitians and the regional sales team.
• Gain knowledge and understand open, unpaid, or rejected claims from the Medical Billing and Collection Team for previous orders.
• Maintain medical records in compliance with HIPAA rules and regulations.
• Adhere to all company Standard Operating Procedures (SOPs) regarding quality and safety.

Requirements

• High School Diploma or equivalent.
• Minimum 2 years of work experience in medical billing, eligibility, authorization, and payer interactions.
• Understanding of HCPCS and ICD10 coding.
• Knowledge of third-party rules and regulations, including contracts and agreements.

Skills and Abilities

• Proficiency in Microsoft Office (Excel, Word, Teams).
• Previous experience with Salesforce or an Order Management System (OMS) preferred but not required.
• Ability to multi-task, with attention to detail to ensure accuracy.
• Able to prioritize work, anticipate department needs, plan accordingly, and handle interruptions with ease.
• Strong written and oral communication skills for providing excellent customer service and Revenue Cycle updates.
• Demonstrated sense of compassion and drive to ensure patients and their families receive optimal coverage.
• Able to work independently with minimal direction, take initiative, and mentor others.
• Able to listen effectively to team members, colleagues, and external customers to identify and initiate suggestions, guidance, and resolutions.
• Results and people-oriented, balancing business and relationship considerations.
• Knowledge of HIPAA and ability to maintain confidential information security.

Benefits

Comprehensive and competitive total rewards package including competitive pay ($25.75-$30.00 per hour), annual bonus opportunity (7.5%), 401(k) with company contributions, medical, dental, and vision insurance (effective day 1), paid time off, company holidays, and floating holidays, paid parental leave, wellness programs and yearly wellness reimbursement, work flexibility, company-paid life and disability insurance, employee assistance program (EAP), tuition reimbursement opportunities, career growth and development within a global organization, and company-provided mental health and caregiving support.

Pay

$25.75 - $30.00 per hour plus 7.5% annual bonus potential.

Schedule

Majority of work is completed in an office setting working inside a controlled temperature environment. Occasional work outside may be required to support employee events. May perform activities in an environment containing hazardous elements and requiring safety awareness and adherence to all safety and GMP policies and guidelines. Work must be performed in a safe manner for personal protection and for the protection of other team members.

Physical Requirements

• Position requires the ability to sit for a minimum of 6 hours per day.
• Ability to stand, walk, bend over, and reach above head on a regular basis.
• Ability to lift or carry up to 25 pounds occasionally and repetitive use of hands/arms for writing, filing, and computer work.

Working Conditions

Majority of work is completed in an office setting working inside a controlled temperature environment. Occasional work outside may be required to support employee events. May perform activities in an environment containing hazardous elements and requiring safety awareness and adherence to all safety and GMP policies and guidelines. Work must be performed in a safe manner for personal protection and for the protection of other team members.