Authorization and Benefits Specialist

Posting Date: 06/06/2019
Closing Date: 07/06/2019
Posting Level: Mid-Level

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:
- 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.


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