Reauthorization Specialist
On-siteLafayette, Louisiana, United States
Job Summary
Review and obtain necessary compliant documentation, medical records, and prescriptions to submit prior authorizations with insurance payors for durable medical equipment. Verify patient demographics and health insurance information daily to process authorizations and appeals, while notifying management of non-compliance or missed deadlines. Answer patient and insurance calls, manage faxing and emails, and maintain effective communication with physicians' offices and internal teams. Report concerns directly to the Revenue Cycle Manager and Supervisor. Requires high school diploma, one year of insurance verification experience, and proficiency in Microsoft Office.
Required Qualifications
- High School Diploma or equivalent
- Minimum of 1 year of insurance verification or authorizations
- Superior organizational skills
- Proficient in Microsoft Office, including Outlook, Word, and Excel
- Attention to detail and accuracy
- Effective/professional communication skills (written and oral)
Desired Qualifications
- 2-4 Years in DME or Medical Office experience preferred
- 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
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