What are the responsibilities and job description for the Authorization Specialist position at Reliable Respiratory?
Equal Opportunity Employer/Disability/Veterans
This is a full-time remote opportunity. To qualify for this position, you must reside within the Commonwealth of MA or the state of CT
About Reliable Respiratory
Reliable Respiratory is a Durable Medical Equipment (DME) company that provides the highest quality level of service for patients in need of respiratory, diabetes, urology, and maternity support. Equipment provided includes, CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, CGM devices, insulin pumps, and breast pumps.
Each patient is treated with professionalism, understanding, and attentive service. We care about our customers, work closely with the medical community, and have highly skilled staff ready to assist customers in receiving the best care possible.
The Authorization Specialist reviews all active rentals, and future claims, to assure proper documentation, prior authorization, and patient eligibility are met to achieve successful payment of claims. This position specifically supports the diabetes product line.
Duties And Responsibilities
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Reliable Respiratory, INC participates in E-Verify. E-Verify is a web-based system that allows an employer to determine an employee's eligibility to work in the US using information reported on an employee's Form I-9. The E-Verify system confirms eligibility with both the Social Security Administration (SSA) and Department of Homeland Security (DHS). For more information, please go to the USCIS E-Verify website.
This is a full-time remote opportunity. To qualify for this position, you must reside within the Commonwealth of MA or the state of CT
About Reliable Respiratory
Reliable Respiratory is a Durable Medical Equipment (DME) company that provides the highest quality level of service for patients in need of respiratory, diabetes, urology, and maternity support. Equipment provided includes, CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, CGM devices, insulin pumps, and breast pumps.
Each patient is treated with professionalism, understanding, and attentive service. We care about our customers, work closely with the medical community, and have highly skilled staff ready to assist customers in receiving the best care possible.
The Authorization Specialist reviews all active rentals, and future claims, to assure proper documentation, prior authorization, and patient eligibility are met to achieve successful payment of claims. This position specifically supports the diabetes product line.
Duties And Responsibilities
- Review DME rentals to ensure they are renting properly
- Responsible for the overall health of the DME accounts that are on hold
- Run regular reports on the status of the DME accounts
- Verify insurance eligibility updates and changes on patients, including contacting payers to investigate and verify the terms and benefits of patients’ insurance policies as well as patient cost
- Research and correct invalid or incorrect patient demographics, insurance inaccuracies, and prescriptions
- Facilitate process for requesting Medical Authorizations and Prior Authorizations for Commercial, Medicaid, and Medicare claims. This includes providing guidance to Physicians and patients regarding documentation required for payer coverage, supporting with appeals for denied claims and following up with payer to determine outcome
- Assists patients with questions or concerns regarding their account, i.e. billing, documentation requirements, and compliance requirements
- Evaluate and escalate “at risk” accounts that do not meet insurance or provider guidelines
- Review and obtain updated CMNs for various DME equipment
- Verify equipment scheduled to be returned or picked up, to assure appropriate billing to patient and insurance
- Analyze monthly rentals that are on manual hold to resume billing activity
- Participate in accounts receivable projects
- Participate in standing meetings as necessary
- Perform other duties and special projects as assigned and directed
- 18 year of age or older
- Must be eligible to work in the United State and not require work authorization from us now or in the future
- High School diploma or equivalent required
- Experience utilizing HICFA 1500 forms and corresponding EOBs preferred
- Effective and professional verbal and written communication abilities
- Great customer service skills
- Professional computer experience (especially Microsoft Office Suite)
- Ability to work independently to investigate and make decisions
- Strong attention to detail
- Ability to prioritize and complete work amidst interruptions in a busy work area
- Available during normal hours of operation
- Ability to comply with guidelines both internal and industry-imposed
- Bilingual in English and Spanish preferred
- Computer Skills
- Customer Service
- Ethics
- Organization Skills
- Productivity
- Results Driven
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to communicate and convey information with the appropriate parties. The job requires assuming a stationary position for long periods of time
- This role routinely uses standard office equipment such as computers, phones, and printers/scanners
- This job operates in a professional office environment
- The noise level in the work environment is usually moderate to loud
Reliable Respiratory, INC participates in E-Verify. E-Verify is a web-based system that allows an employer to determine an employee's eligibility to work in the US using information reported on an employee's Form I-9. The E-Verify system confirms eligibility with both the Social Security Administration (SSA) and Department of Homeland Security (DHS). For more information, please go to the USCIS E-Verify website.
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