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.
-Follow Electromed mission and core values, while striving to achieve company goals -Understand and adhere to local State and Federal healthcare regulatory and compliance rules -Review new order for patient demographics, insurance information, prescription requirements, and medical records -Verify insurance eligibility and DME benefits -Comprehensively navigate payer websites -Competently communicate with payers -Effectively submit insurance requests to obtain authorization -Prepare files for claim submission within timely filing limits -Communicate effectively with internal customers such as Patient Care Coordinators, Patient Services Specialists, and Customer Support Liaisons -Educate patients on complex reimbursement situations -Record information accurately to internal Patient Database -Complete other miscellaneous tasks as needed to help support the reimbursement team.
Typical cubicle office environment.
Required Skills
Required: 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: Experience with DME billing Experience with Medicare part B coverage Experience with national payers
High attention to detail and accuracy with the ability to handle multiple priorities Self-starter, motivated Work well on a team Excellent written and verbal communication skills Demonstrated exceptional customer service skills Knowledgeable 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
High School diploma or GED required. Two or four year related degree preferred.
Required: 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: Experience with DME billing Experience with Medicare part B coverage Experience with national payers
High attention to detail and accuracy with the ability to handle multiple priorities Self-starter, motivated Work well on a team Excellent written and verbal communication skills Demonstrated exceptional customer service skills Knowledgeable 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