Job Description

Position Summary:

The Authorization Specialist is responsible for ensuring that services requiring authorization are provided to patients in compliance with all insurance and regulatory requirements. The Authorization Specialist will be responsible for communicating with insurance companies to obtain necessary authorizations for medical devices, managing patient medical records and ensuring that services are provided and authorized within established guidelines.

Duties and Responsibilities:

Authorizations: 60%

• Communicating with insurance companies to obtain prior authorizations for medical procedures.
• Compile and maintain patient medical records in accordance with legal and regulatory requirements.
• Review patient medical records and insurance documentation to ensure that services provided are authorized.
• Follow up with insurance companies to ensure that authorizations are obtained in a timely manner.
• Document all communication related to the authorization process in patient medical records.
• Resolve technical errors on authorizations with payers.
• Maintain up-to-date knowledge of insurance companies regulations and guidelines related to DME services.
• Coordinate with healthcare teams, and/or customers to obtain information required by the insurance payer in order to obtain an authorization.
• Ensure insurance authorization related tasks are performed accurately, efficiently, and timely to meet department and company goals.
• Work with Configuration to update or create authorization forms when needed.
• Support Operational Projects as directed.

Customer Service: 20%

• Handle incoming and outgoing calls from internal and external team members and insurance payers to create a remarkable experience to help maximize reimbursement and business opportunities.
• Maintain relationships with insurance providers that facilitate a positive partnership.
• Work with online portals and the insurance company to establish the most efficient method of obtaining the authorizations.

Documenting and Reporting: 10%

• Develop and maintain working knowledge of current durable medical equipment (DME) products offered by the company and all applicable insurance guidelines as it relates to eligibility for coverage and reimbursement.
• Ensure insurance related tasks are performed accurately, efficiently, and timely to meet department and company goals.
• Report recurring payer issues or changes.
• Update TIMS as needed regarding billing rules, documentation rules, and payor policy changes when notified.

Other: 10%

• Collaborate with external and internal team members and customers to create a remarkable experience for our customers, maximize reimbursement and business opportunities.
• Cross train within the department to ensure smooth workflow and functional coverage.
• Participate in department meetings.
• Attends HIPAA training and other training sessions as required.
• Understand and comply with all applicable company policies and procedures.
• Comply with all applicable local/state/federal regulations related to the medical device and durable medical equipment industries.
• Perform other related duties as directed by supervisor.

Required Qualifications:

• High School education or GED required.
• Preferred 2 years’ experience working for or with medical insurance companies in a healthcare setting, preferably in an authorization role.

Additional Qualifications:

• Durable Medical Equipment (DME) experience preferred.
• Demonstrated superior customer service skills.
• Excellent communication skills, both verbal and written
• Strong analytical and problem-solving skills.
• Ability to organize and prioritize workload.
• Ability to work independently and as part of a team.
• Strong knowledge of Microsoft Office products - Outlook, Word, and Excel

Physical Requirements of the Position:

Candidate must be able to sit at a desk in front of a personal computer (PC) monitor for long periods of time. Position requires incumbent to use a PC, telephone, and basic office equipment. This position requires the candidate can conduct telephone conversations, read medical and insurance information, and communicate clearly with all internal and external customers.

How We Work Together

We believe that we are better together than apart. Onsite roles require full-time presence in the company’s facilities. Field roles are most effectively done outside of the company’s main facilities, generally at the customers’ or suppliers’ locations.

The pay rate for this role is $25.00 per hour

For this project, you’ll be contracted via a Randstad company as a temporary worker/contractor and placed at our Client. As a contractor, you'll enjoy cutting-edge challenges and unexpected experiences that make you a more in-demand professional .

Equal Opportunity Employer

Randstad is an equal opportunities employer and does not discriminate against Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status. At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact kari.carapella@randstadsourceright.com

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