Prior Authorization Specialist Since our doors opened in 1989, Reliable Medical has been committed to improving the lives of all who entrust us with their care and those who we entrust to provide it. We strive to be the premier provider of complex mobility solutions and other critical services for customers seeking compassionate care and optimal outcomes. Our mission is to improve the lives of those we serve by providing best in class service to customers, education, product expertise and dedicated partnership to clinicians, and development, careersatisfaction and work-life balance to our team members. We aspire to bring our mission to new communities and to reinvest our growth into improving lives, treating one another and our customers, like family. Brief description The Prior Authorization Specialist plays a crucial role in ensuring that patients receive timely access to necessary home medical equipment. This position involves meticulously reviewing medical documentation, preparing pre-authorization requests, and communicating with insurance providers to secure approvals. The specialist must navigate complex billing codes and insurance requirements while working collaboratively with various departments to provide seamless patient care. Essential Functions - Review diverse medical documentation and prepare pre-authorization requests for a variety of home medical equipment.
- Follow up with insurance providers on submission statuses to secure timely approvals and manage any denials effectively.
- Initiate and manage appeals for denied authorizations, exploring every possibility for patient approval.
- Utilize various methods for pre-authorization submissions, including fax, phone, email, website portals, and other communication channels.
- Develop proficiency in HCPC billing codes, medical terminology, and interpreting complex chart notes for accurate processing.
- Understand the specific requirements of each insurance company and navigate the intricacies of submitting pre-authorization requests for each provider.
- Collaborate within a high-paced team environment to ensure timely provision of crucial equipment for patients.
- Communicate effectively and professionally with insurance companies, sales representatives, the billing department, and team members to streamline the authorization process.
- Perform other duties as assigned by management.
Qualifications and requirements - High School Diploma or equivalent.
- Prior work experience in a professional office environment is essential.
- Previous experience in Prior Authorization and/or Durable Medical Equipment (DME) is mandatory.
- Working knowledge of durable medical equipment is advantageous.
- Proficiency in basic computer skills, including Microsoft Office Suite (Outlook, Word, Excel, SharePoint, etc.).
- Exceptional interpersonal skills for building rapport and maintaining professional relationships with various stakeholders.
- Highly self-motivated, with the ability to work both independently and collaboratively within a team.
- Strong verbal and written communication skills, with a keen eye for detail and accuracy.
Competencies - Detail-oriented and thorough in reviewing medical documentation and processing requests.
- Strong analytical skills for interpreting complex chart notes and billing codes.
- Proactive and persistent in following up with insurance providers and managing denials.
- Effective communication and interpersonal skills for interacting with various departments and external stakeholders.
- Ability to work efficiently in a high-paced team environment.
- Problem-solving skills for managing appeals and finding solutions for denied authorizations.
Physical Requirements - Ability to work at a computer for extended periods.
- Effective use of office equipment such as telephones, computers, and fax machines.
- Occasional lifting of office supplies and medical documentation files.
Our Commitment to you: - Work-Life Balance and Flexibility: Enjoy a guaranteed 40 hours per week, with no weekends required.
- Comprehensive Health Coverage: We provide excellent health, dental, and vision insurance coverage to prioritize the well-being of yourself and your family.
- Generous Paid Time Off: Maintain a healthy work-life balance with our generous PTO policy, including vacation days and paid holidays.
- Professional Development Opportunities: Grow your skills and advance your career with access to professional development opportunities including education programs, ongoing training, company sponsored workshops/events.
- Retirement Savings Plan: Prepare for your future with our 401(k) retirement savings plan, which includes company matching contributions.
- Wellness Programs: Participate in our wellness initiatives, such as wellness challenges and access to mental health resources, to support your overall well-being.
- Inclusive and Diverse Workplace: Be part of an inclusive team where everyone's contributions are valued and respected.
- Volunteer Opportunities: Additional paid time off to volunteer and support community initiatives. This benefit is known as “VTO – Volunteer Time Off”.
- Employee Recognition Programs: Awards and celebrations for outstanding achievements.
- Service Awards: Recognition for long-term employees with milestone rewards.
- Parental and Childbirth Leave: Receive support and time off for parental and childbirth leave to prioritize family needs during significant life events.
At Reliable Medical, we prioritize your well-being and growth, providing benefits that make your career journey both rewarding and fulfilling. Join us and experience the difference! Reliable Medical is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.
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