HME Authorization Specialist
On-siteAustin, Texas, United States
Job Summary
Coordinate with internal and external teams to collect, verify patient information, and manage document transfers between software platforms. Scan mailed payor responses into Brightree and Salesforce systems, verify coding and cost details, and compile prior authorization packets for submission through Payor Portals. Monitor authorization steps to ensure timeliness, update patient records based on responses, and place calls to DOL Medical Benefits Examiners to clarify processing decisions. Act as a liaison between patients, clinicians, and payers to facilitate seamless communication and service delivery. This role supports the HME Operations Team in managing all prior authorization requests to the Department of Labor while collaborating with billing departments for pricing updates.
Required Qualifications
- High school diploma or GED
- Must be able to work collaboratively in a fast-paced, compliance-focused healthcare environment
- Must be able to stand, sit, or lift equipment up to 50 pounds
- Must be able to communicate effectively and professionally with Payor representatives
- Must be able to communicate effectively and professionally with patients/care team members/DOL
- Must be able to act as a liaison between patients, Home Health teams, clinicians, and payers
- Must be able to place calls to DOL Medical Benefits Examiners
- Must be able to receive calls from DOL Medical Benefits Examiners
- Must be able to verify appropriate coding, cost, frequency and duration of requested Medical Equipment
- Must be able to compile Prior Authorization packets and submit them through Payor Portals
- Must be able to manage Payor Portal Authorization updates
- Must be able to update Patient Records appropriately based on Authorization responses
- Must be able to update Salesforce and Brightree appropriately based on Authorization responses
- Must be able to monitor Authorization steps taken to ensure timeliness and compliance
- Must be able to complete tasks and Authorization requests promptly and within allowable timelines
- Must be able to coordinate with internal Giving Home Medical Equipment, Home Health Care, and external referral sources
- Must be able to manage Document transfers from software platforms
- Must be able to communicate with internal and external team members when necessary
- Must be able to scan mailed responses from Payors into Brightree and Salesforce systems
- Must be able to assist HME Operations with the monitoring and working of reports
- Must be able to collaborate with Billing Departments for Pricing/Fee Schedule Updates
- Must be able to collaborate with HME and Home Health departments as necessary
- Must be able to communicate with patients/care team members/DOL via inbound and outbound phone calls
- Must be able to perform Other Duties as Necessary
- Background check
- Fingerprinting
- TB test
Desired Qualifications
- Associate's or Bachelor's degree in a healthcare-related field
- Minimum 3 years of experience in a DME business environment
- Familiarity with DOL, DEEOIC, and private insurance billing processes
- Deep and instinctual understanding of Durable Medical Equipment and Home Medical Equipment
- Excellent communication and customer service skills
- Strong and kind phone presence
- Detail-oriented with strong organizational abilities
- Brightree Experience
- Salesforce experience
- Strong time management skills
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