Prior Authorization & Billing Specialist

Reliable-Respiratory; Dartmouth (MA); On-site; USD 28,000 - 40,000; Full time

Job summary

Reliable Respiratory, INC is seeking an Authorization Specialist in Beverly, MA to review rentals, ensure proper documentation, prior authorization, and patient eligibility for successful claims processing. You will collaborate with caregivers, payors, and clinics to maintain accurate records and timely billing.

The role requires 18+ years, US work eligibility, and an associate degree or equivalent experience; daily tasks include verifying insurance, updating charts, and handling billing tasks

Qualifications

• 18 years of age or older.
• US work authorization required now or in the future.
• Associate’s degree required or 2 years of relevant experience.

Responsibilities

• Provide exceptional service every time.
• Meet or exceed annual performance indicators as outlined by organizational leadership.
• Complete assigned tasks and worklists in a timely manner.
• Ensure scheduled dates of service for equipment rentals bill on time and correctly.
• Ensure supply orders can be placed and delivered to the patients when eligible for new supplies.
• Work with providers and patients to obtain necessary and current medical documentation.
• Stay up to date on insurance guidelines and their authorization and billing requirements.
• Ensure patient charts are up to date and accurate.
• Update patient insurance policies and adjust sales orders as needed.
• Perform basic billing functions including but not limited to credit adjustments and recalculation of billing dates of service to ensure sales orders bill correctly.
• Verify patients’ insurance eligibility, including contacting payors to investigate and verify the terms and benefits of patients’ insurance policies and costs.
• Facilitate process for requesting prior authorizations for Commercial, Medicaid, and Medicare Policies.
• Work with providers and patients to help them understand requirements for payor coverage including but not limited to: Authorization and compliance requirements
• Appeals for denied services / claims
• Process payment for services rendered.
• Evaluate and/or escalate patient accounts that do not meet insurance or provider guidelines.
• Troubleshoot equipment issues with patients.
• Refer issues to the Reliable clinical team, manufacturer’s care teams or referring provider as needed.
• Verify equipment scheduled to be returned or picked up, to ensure appropriate billing to patient and/or insurance.
• Actively participate in meetings as necessary.
• Perform other duties and special projects as assigned and directed.

Skills

Problem solving

Active listening

Decision making

Customer service

Attention to detail

Microsoft Office

Independent worker

Team collaboration

Education

Associate’s degree or 2 years of relevant experience

Tools

Microsoft Office Suite

Job description

Reliable Respiratory, INC is seeking an Authorization Specialist in Beverly, MA to review rentals, ensure proper documentation, prior authorization, and patient eligibility for successful claims processing. You will collaborate with caregivers, payors, and clinics to maintain accurate records and timely billing.

The role requires 18+ years, US work eligibility, and an associate degree or equivalent experience; daily tasks include verifying insurance, updating charts, and handling billing tasks