Reauthorization Specialist

Sleep Management, LLC dba Viemed

Reauthorization Specialist

Job Category: Sleep Management, LLC
Requisition Number: REAUT003341
Full-Time

Duties:

1. Review and obtain necessary compliant documentation, medical records and prescriptions in order to submit for prior authorization with insurance.
2. Responsible for obtaining prior authorization from insurance payor for durable medical equipment.
3. Verifies patient demographic and health insurance information to review & work pending task daily for authorizations &/or appeals
4. Notify RT/Sales management teams regarding non-compliance and authorization deadlines that are not met
5. Establishes and maintains effective communication and good working relationships with patients/family, physicians’ offices, and other internal teams for the patient’s benefit.
6. Performs other clerical tasks as needed, such as
   • Answering patient/Insurance calls
   • Faxing and Emails
7. Communicates appropriately and clearly to Manager/Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor
8. 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)

We are an equal opportunity employer and all qualified applicants will receive consideration without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other characteristic protected by law.

By submitting your application and participating in the interview process, you acknowledge and consent that interviews, video meetings, phone screenings, and other recruiting interactions may be recorded for evaluation, training, quality assurance, compliance, and hiring purposes. These recordings may be reviewed by authorized company personnel and may be processed using artificial intelligence or automated tools to assist with notetaking, transcription, scheduling, candidate evaluation support, and other recruiting functions. No employment decision will be based on automated processing. By submitting an application and participating in the interview process, you acknowledge and consent to the recording and processing in accordance with applicable laws and company privacy policies.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the notice from the Department of Labor.

Equal employment opportunity, including veterans and individuals with disabilities.

PI285185639