Prior Authorization & Billing Specialist

Reliable Respiratory; Norwood (MA); On-site; USD 42,000 - 64,000; Full time

Job summary

Reliable Respiratory, a DME company, seeks an Authorization Specialist to review rentals, ensure proper documentation, and verify patient eligibility to achieve successful claim payments while providing exceptional service to patients, payors, providers, and teammates.

The role requires coordinating with providers and patients, staying current with insurance guidelines, and processing billing tasks, with a focus on accuracy and timely action.

Qualifications

• 18 years of age or older.
• Eligible to work in the United States and not require work authorization from us now or in the future.
• Associate's degree required or 2 years of relevant (authorization, claims, billing) 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
• Process payment for services rendered.
• Evaluate and/or escalation 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

Judgment

Communication

Customer service

Attention to detail

Independent work

Team collaboration

Organization

Productivity

Ethics

Education

Associate's degree

2 years relevant experience

Tools

Microsoft Office Suite

Job description

Reliable Respiratory, a DME company, seeks an Authorization Specialist to review rentals, ensure proper documentation, and verify patient eligibility to achieve successful claim payments while providing exceptional service to patients, payors, providers, and teammates.

The role requires coordinating with providers and patients, staying current with insurance guidelines, and processing billing tasks, with a focus on accuracy and timely action.