Authorization Specialist

Authorization Specialist

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 ensure proper documentation, prior authorization, and patient eligibility are met to achieve successful payment of claims while providing exceptional service to our patients and their families, payors, providers and team members.

Duties and Responsibilities

• Provide exceptional service every time.
• Meet or exceed annual performance indicators as outlined by organizational leadership.
• Complete assigned tasks and worklists in a timely manner.
• Ensure scheduled dates of service for equipment rentals bill on time and correctly.
• Ensure supply orders are placed and delivered to the patients when eligible for new supplies.
• Work with providers and patients to obtain necessary and current medical documentation.
• Stay up to date on insurance guidelines and their authorization and billing requirements.
• Ensure patient charts are up to date and accurate.
• Update patient insurance policies and adjust sales orders as needed.
• Perform basic billing functions including but not limited to credit adjustments and recalculation of billing dates of service to ensure sales orders bill correctly.
• Verify patients' insurance eligibility, including contacting payors to investigate and verify the terms and benefits of patients' insurance policies and costs.
• Facilitate process for requesting prior authorizations for Commercial, Medicaid, and Medicare Policies.
• Work with providers and patients to help them understand requirements for payor coverage including but not limited to :

Authorization and compliance requirements

Refer issues to the Reliable clinical team, manufacturer's care teams or referring provider as needed.

Basic Qualifications

Required Skills

Competencies

Work Environment & Physical Demands

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.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

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.