The Authorization and Benefits Specialist is responsible for reviewing and processing new referrals; maintaining paper and electronic files; filing; verifying patient's benefits and eligibility; submitting and monitoring insurance prior authorization requests; preparing files for claim submission; actively working with internal customers; handling day to day administrative tasks within the reimbursement department. This position will be remote for the time being, with a possibility of a hybrid situation going forward. 

ESSENTIAL JOB FUNCTIONS:      

1. Understand and adhere to local State and Federal healthcare regulatory and compliance rules.

2. Review new orders for patient demographics, insurance information, prescription requirements and medical records.

3. Verify insurance eligibility and DME benefits.

4. Effectively communicate with payers.

5. Comprehensively navigate payer websites.

6. Effectively submit insurance requests to obtain authorization.

7. Prepare files for claim submission within timely filing limits.

8. Communicate effectively with internal customers such as Patient Care Coordinators, Patient Services Specialists and Customer Support Liaisons.

9. Educate patients on complex reimbursement situations.

10. Accurately record information to internal Patient Database.

11. Complete other miscellaneous tasks as needed to help support the reimbursement team.

12. Perform other duties as assigned.

Required Skills

SKILLS AND ABILITIES:   

• High attention to detail and accuracy with the ability to handle multiple priorities.
• Self-starter, motivated.
• Works well in a team environment.
• Excellent written and verbal communication skills.
• Demonstrated exceptional customer service skills.
• Knowledge of insurance requirements and have the ability to determine medical justification to ensure proper reimbursement.
• Ability to prioritize and organize.
• Strong analytical and problem-solving skills.
• Active participant of continuous improvement.

Required Experience

EDUCATION AND EXPERIENCE REQUIREMENTS:

Required:

• High School diploma or GED.
• Minimum of 2-year experience working with insurance companies in the capacity of benefits & coverage, and authorizations.
• Minimum of 1-year experience working directly with third party or government payers.
• Experience with medical terminology.
• Experience with typical office equipment.
• Knowledge of Microsoft Office suite.

Preferred:

• 2- or 4-year related degree.
• Experience with DME billing.
• Experience with Medicare part B coverage.
• Experience with national payers.

SKILLS AND ABILITIES:   

• High attention to detail and accuracy with the ability to handle multiple priorities.
• Self-starter, motivated.
• Works well in a team environment.
• Excellent written and verbal communication skills.
• Demonstrated exceptional customer service skills.
• Knowledge of insurance requirements and have the ability to determine medical justification to ensure proper reimbursement.
• Ability to prioritize and organize.
• Strong analytical and problem-solving skills.
• Active participant of continuous improvement.