Prior Authorization Specialist

Prior Authorization Specialist

Company Overview:

Mountain Medical Supply (MMS) is a national durable medical equipment (DME) company dedicated to providing top-quality medical equipment and supplies to former U.S. Department of Energy workers (and their families) who became ill due to toxic and radiological exposures at covered Department of Energy facilities. Our mission is to help these individuals achieve the best possible quality of life through reliable, compassionate service.

The Prior Authorization Specialist is responsible for the successful completion of prior authorizations for Medical Equipment. This process requires high levels of organization, dedication, and persistence. The position serves as an advocate for patients to obtain approvals for their Durable Medical Equipment through the Department of Labor. Primarily a Remote position with some in office meeting or work, usually 1-2 times per month. Training will be done in the office for 1-2 weeks.

Key Responsibilities

• Writing letters of medical necessity.
• Comfortable with talking on the phone.
• Comfortable working daily with insurance payers to gain prior authorization approval.
• Comfortable working with remote teams in multiple states.
• Understands and accurately applies requirements for prior authorization.
• Ensures eligibility and benefits are properly verified.
• Exhibits excellent customer service skills and serves as an advocate for the patient.
• Performs other related duties as assigned or requested in order to maintain a high level of service.
• Demonstrates professional work behavior by following Service Standards and Success factors.
• Complies with departmental organizational policies and procedures and adheres to external agency requirements.
• Ensure compliance with coding and billing regulations, including HIPAA and other industry guidelines.
• Maintain accurate and up-to-date documentation of job-related activities, including authorizations, claims, appeals, and communication internally and externally.

Required Knowledge and Skills

• Demonstrated work history of being successful at handling prior authorizations, appeals and denials.
• Demonstrates clear communication and effective collaboration to optimize patient care and clinic operations.
• Strong writing skills.
• Excellent customer service skills.
• Ability to collaborate with others and offer outstanding customer service.
• Demonstrates a High degree of computer literacy in a PC environment.
• Strong organizational, interpersonal and communication skills.
• Previous experience of successfully completing federal payer authorizations preferred.
• Strong attention to detail and accuracy in data entry, documentation, and claims processing.
• Ability to handle confidential and sensitive information with discretion.
• Strong problem-solving and analytical skills to identify and resolve issues.
• Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
• Knowledge of medical terminology, anatomy, and diagnosis codes, and or procedures.
• Ability to work independently in a remote setting while effectively managing team collaboration and project deadlines.
• Organized, proactive, and able to identify and address potential issues swiftly.

Education/Licensure/Technical Requirements.

• High school Diploma or equivalent required.
• Medical Assistant Degree or equivalent preferred.
• 2 years Medical Office Experience preferred.
• Brightree Experience preferred.
• Six months of experience with prior authorizations, federal and commercial preferred.
• Ability to meet U.S. employment and eligibility requirements.

Details and Benefits:

• Hours: 30-40 per week, flexible daytime working hours anywhere between 6 am-5 pm, M-F. If work is completed, no one else needs help, and you want to be finished for the day, less hours are fine but see PTO policy below.
• PTO: 120 hours paid time off, per year, to be used for sick time, vacation, personal leave....etc., after temporary hire arrangement completed. Full PTO time is dependent on at least 30 hours a week, 6-month average maintained. Otherwise, PTO drops to 48 hours per year. Holiday and Bereavement Pay do not deduct from PTO hours.
• Paid Holidays: New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving (Observed Friday after Thanksgiving), Christmas Day (Observed Christmas Day 1 TBD)
• Bereavement Pay: 3-7 days for immediate family.
• Location: Remote position after training, monthly or bimonthly in person meetings/trainings in Provo, UT or prn. Occasional various team building activities in various locations. In-office employment may be implemented with one-month prior notification as required, or if the employee is unable to work remotely, and is always available.
• Equipment provided: Laptop, two monitors, keyboard, mouse. Stand-up desk attachment if desired.
• Temp to Hire Duration: 2-month temporary status will transition into full time employment if agreeable between both parties. Temporary employment within the first two months may be terminated at any time from either party. Temporary Employment contract will be signed. Full-time employment may be offered, and a new employment contract will be signed.