Prior Authorization Specialist - Sleep Therapy

Aeroflow Health – Prior Authorization Specialist - Sleep Therapy - Fully Remote Opportunity

Starting Pay: $20 an hour

The Opportunity

The Sleep Billing Team at Aeroflow currently consists of 18 members, dedicated to collecting outstanding payments from health insurance companies or patients. We primarily serve patients who receive continuous positive airway pressure (CPAP) and non-invasive ventilation equipment and supplies through Aeroflow Sleep.

The Billing department includes the following roles:

• Customer Service Representatives
• Insurance Billing Specialists
• Prior Authorization Specialists

Your Primary Responsibilities

Prior Authorization Processing:

• Review requests for sleep therapy services and equipment to assess the need for prior authorization.
• Collect necessary patient information, including medical history, insurance details, and prescribing physician information.
• Verify insurance coverage and familiarize with specific prior authorization requirements for various payers.
• Initiate prior authorization requests through the correct channels, adhering to established procedures and guidelines.
• Monitor the progress of prior authorization requests and follow up as needed to expedite approvals.
• Collect, organize, and analyze data from various sources to support decision-making and improve operational efficiency.
• Prepare regular reports on data insights and present findings to management, offering actionable recommendations based on trend analysis.
• Collaboration: Work with cross-functional teams to understand business needs and deliver data-driven insights to improve processes and outcomes.

Documentation and Record-keeping:

• Maintain accurate and up-to-date records of prior authorization requests, approvals, denials, and appeals.
• Ensure all required documentation, such as sleep study reports, physician prescriptions, and medical necessity information, is complete and submitted properly.
• Organize and securely store patient and insurance information in a confidential manner.

Communication and Coordination:

• Communicate with prescribing physicians, sleep specialists, and other healthcare providers to gather necessary information for prior authorization requests.
• Collaborate with insurance companies and relevant parties to streamline the prior authorization process.
• Advocate for patients by providing supporting documentation to demonstrate the medical necessity of sleep therapy services and equipment.
• Educate patients about their insurance coverage, prior authorization requirements, and the importance of adherence to sleep therapy treatments.

Compliance and Quality Assurance:

• Ensure adherence to regulatory requirements and insurance policies related to prior authorizations for sleep therapy.
• Stay informed about changes in insurance regulations, coverage policies, and prior authorization procedures specific to sleep therapy.
• Identify opportunities to improve processes and contribute to quality assurance initiatives within the department.
• Employee has an individual responsibility for knowledge of and compliance with laws, regulations, and policies.
• Compliance is a condition of employment and is considered an element of job performance
• Maintain HIPAA/patient confidentiality
• Other job duties assigned

Required Qualifications

• Skilled at identifying trends or issues within data and proposing actionable solutions based on insights.
• Exceptional attention to detail to ensure accurate analysis and identification of meaningful data trends.
• Previous experience in prior authorization, insurance verification, or medical billing, particularly in the sleep medicine or DME (durable medical equipment) field, is highly preferred.
• In-depth understanding of medical terminology, insurance processes, sleep disorders, and treatment options.
• Excellent verbal and written communication skills, with the ability to professionally interact with patients, healthcare providers, and insurance representatives.
• Proficient in using electronic health record (EHR) systems, billing software, and Microsoft Office Suite applications.
• Capable of working independently, prioritizing tasks, and managing time effectively in a fast-paced environment.
• Strong knowledge of HIPAA regulations and a commitment to maintaining patient confidentiality.
• Regular and reliable attendance as assigned by your schedule

Skills for Success

• Relentless Curiosity: Proactively seeks out opportunities for process improvements.
• Entrepreneurial: Identifies and acts on new opportunities with a willingness to take calculated risks.
• Obsession to Learn: Actively seeks out opportunities to learn and grow and identifies areas for self-improvement.
• Confidentially Humble: Freely admits knowledge gaps and seeks help from team members, and regularly solicits feedback.
• Strategic: Makes decisions and takes actions with a broader organizational impact.
• Transformative: Constantly seeks ways to improve and actively pursues growth opportunities.
• Tech-Savvy: Keeps up to date with modern technology and regularly develops and refines processes within the team.
• Commitment to People Development: Shows passion for developing talent through regular training and mentoring.
• Relationship Focused: Proactively builds relationships across the organization.

You might also have

• Proficiency in healthcare and insurance, as it pertains to billing and reimbursement.
• Excellent written and verbal communication skills for stakeholder engagement and effective team collaboration.
• Strategic thinker with a commitment to transformative changes and growth opportunities.
• Highly organized with exceptional time-management skills.

What Aeroflow Offers

Competitive Pay, Health Plans with FSA or HSA options, Dental, and Vision Insurance, Optional Life Insurance, 401K with Company Match, 12 weeks of parental leave for birthing parent/ 4 weeks leave for non-birthing parent(s), Additional Parental benefits to include fertility stipends, free diapers, breast pump, Paid Holidays, PTO Accrual from day one, Employee Assistance Programs and SO MUCH MORE!!

Here at Aeroflow, we are proud of our commitment to all of our employees. Aeroflow Health has been recognized both locally and nationally for the following achievements:

• Family Forward Certified
• Great Place to Work Certified
• Inc. 5000 Best Place to Work award winner
• HME Excellence Award
• Sky High Growth Award

If you’ve been looking for an opportunity that will allow you to make an impact, and an organization with unlimited growth potential, we want to hear from you!

Aeroflow Health is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.