As a Prior Authorization Specialist, you will play a critical role in ensuring that patients receive the necessary approvals for their medical equipment. Your attention to detail and expertise in navigating complex insurance requirements will be key in facilitating smooth and timely authorizations. This role requires a strong understanding of HCPCS coding, insurance procedures, and patient care.

Key Responsibilities:

• Review and process prior authorization requests for DME in accordance with insurance company requirements.
• Verify patient eligibility and benefits through various payer portals and systems.
• Communicate with healthcare providers, patients, and insurance companies to obtain necessary documentation and approvals.
• Ensure compliance with all regulatory requirements and payer guidelines.
• Maintain accurate and detailed records of all authorization requests and communications.
• Resolve authorization issues and denials in a timely manner, including appealing decisions when necessary.
• Stay updated on changes in insurance policies, procedures, and coding requirements to ensure accurate processing.

Qualifications:

• Minimum of [2] years of experience in medical billing, with a focus on payer medical policies.
• Strong understanding of prior authorization processes, including patient eligibility and reimbursement methodologies
• Experience in durable medical equipment billing is highly preferred
• Proficiency in using billing software and electronic health records (EHR) systems
• Familiarity with Brightree software is a definite plus
• Excellent attention to detail and accuracy
• Strong analytical and problem-solving skills
• Ability to work independently and collaboratively in a fast-paced environment
• Exceptional organizational and time management abilities
• Excellent communication skills, both verbal and written

Job Type: Full-time

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: In person