Reliable Respiratory · 1 week ago
Authorization Specialist
United States
Full-time
Remote
New Grad, Entry LevelReliable Respiratory is a Durable Medical Equipment (DME) company that provides high-quality service for patients in need of respiratory and other medical support. The Authorization Specialist reviews DME rentals and future claims to ensure proper documentation and patient eligibility for successful payment of claims, specifically supporting the diabetes product line.
MedicalMedical Device
No H1B
Hiring Manager
Jenavi Rojas
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
Qualification
Required
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
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
Preferred
Experience utilizing HICFA 1500 forms and corresponding EOBs preferred
Bilingual in English and Spanish preferred
Company
Reliable Respiratory
Reliable Respiratory operates as a home respiratory and specialty medical equipment providers.
Founded in 2009
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase