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VieMed Healthcare Linkedin · Posted 5d ago

Reauthorization Specialist

Lafayette

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Indexed description

­­­­­­­­­­­­­­­­­­­ Duties:

  • Review and obtain necessary compliant documentation, medical records and prescriptions in order to submit for prior authorization with insurance.
  • Responsible for obtaining prior authorization from insurance payor for durable medical equipment.
  • Verifies patient demographic and health insurance information to review & work pending task daily for authorizations &/or appeals
  • Notify RT/Sales management teams regarding non-compliance and authorization deadlines that are not met
  • Establishes and maintains effective communication and good working relationships with patients/family, physicians’ offices, and other internal teams for the patient’s benefit.
  • Performs other clerical tasks as needed, such as
    • Answering patient/Insurance calls
    • Faxing and Emails
  • Communicates appropriately and clearly to Manager/Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor
  • Other responsibilities and projects as assigned.

Requirements:

  • High School Diploma or equivalent.
  • Learns and maintains knowledge of current patient database and billing system
  • Verifying Insurance for all products
  • Understand Insurance benefit breakdown of deductibles and co-ins
  • Understand Insurance Medical and Payment Policies
  • Knowledge of Explanation of Benefits from insurance companies
  • General knowledge of government, regulatory billing and compliance regulations/policies for Medicare & Medicaid
  • Working knowledge of CPT and ICD-10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits.
  • Enough knowledge of policies and procedures to accurately answer questions from internal and external customers.
  • Utilizes initiative while maintaining set levels of productivity with consistent accuracy.

Experience:

  • 2-4 Years in DME or Medical Office experience preferred.
  • Minimum of 1 year of insurance verification or authorizations required.

Skills:

  • Superior organizational skills.
  • Proficient in Microsoft Office, including Outlook, Word, and Excel.
  • Attention to detail and accuracy.

Effective/professional communication skills (written and oral)
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