Reauthorization Specialist

VieMed Healthcare; Lafayette (LA); On-site; USD 36,000 - 54,000; Full time

Job summary

VieMed Healthcare is seeking a detail-oriented Prior Authorization Clerk in Lafayette, LA to manage insurance verification and prior authorizations for DME products. You will coordinate with patients, physicians, and internal teams to ensure timely submissions and accurate documentation.

The role requires 1+ year of insurance verification or authorizations and 2–4 years in DME/medical office settings, with strong knowledge of CPT/ICD-10, HIPAA and billing policies.

Qualifications

• 2–4 years in DME or medical office experience preferred.
• Minimum of 1 year of insurance verification or prior authorizations required.
• Knowledge of CPT/ICD-10 codes, HCFA 1500 forms, HIPAA and billing regulations.
• Understanding Medicare & Medicaid policies and benefits.
• Familiarity with Explanation of Benefits (EOBs).
• General knowledge of government/regulatory billing and compliance.

Responsibilities

• Review and obtain compliant documentation to submit for insurance prior authorization.
• Obtain prior authorization from insurance payors for DME.
• Verify patient demographics and insurance information; process authorizations/appeals.
• Notify management of non-compliance and missed authorization deadlines.
• Maintain communication with patients, physicians’ offices, and internal teams.
• Handle clerical tasks such as answering calls, faxing, and emailing.
• Report concerns to Revenue Cycle Manager and Supervisor.
• Contribute to other duties as assigned.

Skills

Organizational skills

Microsoft Office

Attention to detail

Communication skills

Education

High School Diploma or equivalent

Tools

Billing software

Job description

Duties

• Review and obtain necessary compliant documentation, medical records and prescriptions in order to submit for prior authorization with insurance.
• Responsible for obtaining prior authorization from insurance payor for durable medical equipment.
• Verifies patient demographic and health insurance information to review & work pending task daily for authorizations &/or appeals.
• Notify RT/Sales management teams regarding non-compliance and authorization deadlines that are not met.
• Establishes and maintains effective communication and good working relationships with patients/family, physicians’ offices, and other internal teams for the patient’s benefit.
• Performs other clerical tasks as needed, such as
  • Answering patient/Insurance calls
  • Faxing and Emails
• Communicates appropriately and clearly to Manager/Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor.
• Other responsibilities and projects as assigned.

Requirements

• High School Diploma or equivalent.
• Learns and maintains knowledge of current patient database and billing system.
• Verifying Insurance for all products.
• Understand Insurance benefit breakdown of deductibles and co-ins.
• Understand Insurance Medical and Payment Policies.
• Knowledge of Explanation of Benefits from insurance companies.
• General knowledge of government, regulatory billing and compliance regulations/policies for Medicare & Medicaid.
• Working knowledge of CPT and ICD-10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits.
• Enough knowledge of policies and procedures to accurately answer questions from internal and external customers.
• Utilizes initiative while maintaining set levels of productivity with consistent accuracy.

Experience

• 2-4 Years in DME or Medical Office experience preferred.
• Minimum of 1 year of insurance verification or authorizations required.

Skills

• Superior organizational skills.
• Proficient in Microsoft Office, including Outlook, Word, and Excel.
• Attention to detail and accuracy.
• Effective/professional communication skills (written and oral).