Reimbursement Authorization Specialist I

This position is located in Ayer, MA with flexibility for limited remote work. Core hours of operation are 8:30 am to 5:00 pm.

Qualifications

• Minimum High School Diploma or equivalent; College degree a plus.
• 2+ years work experience in medical billing, eligibility, authorization, and interaction with payers.
• Understanding of HCPCs and ICD10 coding.
• Knowledge of third-party rules and regulations to include contracts and agreements.

Skills

• Proficiency in Microsoft Office (Excel, Word, Teams, etc.).
• 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, and handle interruptions with ease.
• Strong written and oral communication skills to provide excellent customer service and Revenue Cycle updates.
• Demonstrated sense of compassion and drive to ensure patients and their families receive optimal coverage for Cambrooke products.
• Ability to work independently with minimal direction and take initiative within scope of responsibilities.
• Strong team player who can initiate activity, communicate promptly, and mentor others.
• Great listening skills to work with team members, colleagues, and external customers to identify and resolve issues.
• Results and people-oriented, balancing business and relationship considerations.
• Knowledge of HIPAA and ability to maintain confidential information security.

Working Conditions / Physical Requirements

• Majority of work is completed in an office setting with controlled temperature.
• Occasional work outside may be required to support employee events.
• May perform activities in an environment containing hazardous elements, requiring safety awareness and adherence to all safety and GMP policies.
• Work must be performed safely to protect self and team members.
• 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.
• Repetitive use of hands/arms for writing, filing, and computer work.
• Ability to wear required personal protective equipment when entering the manufacturing environment.

Responsibilities

• Ensure Ajinomoto Cambrooke, Inc. (ACI) has the necessary documentation to start the referral process.
• Contact healthcare professionals, state agencies, and payers (insurance companies) for clinical documents, eligibility, benefits, prior authorization, single case agreements, letter of agreements, and other items to ensure payment on an as-needed basis (e.g., when authorization expires).
• Assist in uploading current documents and populating required fields in SalesForce.
• Maintain documents so effective dates are always current.
• Ensure all incoming requests are worked and responded to timely, following Revenue Cycle Department guidelines.
• Coordinate with other contracted Durable Medical Equipment companies and/or Pharmacies to ensure patients and their families can obtain required formula and medical foods.
• Provide assistance and guidance to patients and their families through eligibility, benefit verification, and prior authorization processes with payers.
• Deliver excellent customer service, resolving inquiries and issues in a timely, professional, and compassionate manner to ensure optimal coverage for Cambrooke products with minimal financial impact.
• Prioritize all Pre-Orders waiting for the most recent SalesForce Case to be finalized with all documents signed and approved.
• Communicate and collaborate with registered dietitians and the regional sales team.
• Converse with the Medical Billing and Collection Team to understand open, unpaid, or rejected claims for previous orders.
• Maintain medical records in compliance with HIPAA rules and regulations.
• Adhere to all company SOPs regarding quality and safety.
• Other duties as assigned.

Pay

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