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.
- 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.
- 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.