Hybrid Reauthorization Specialist - Remote Reauthorization Specialist - Remote with verification

Job Type

Full-time

Description

Promptcare is seeking a highly motivated and detail-oriented Reauthorization Specialist to join our team. The Reauthorization Specialist will be responsible for obtaining and maintaining insurance authorizations for respiratory therapy services. The ideal candidate will have experience in healthcare insurance and be able to work in a fast-paced environment. The successful candidate should reside in Central or Eastern time zones. If you are a self-starter with a passion for healthcare and a desire to make a difference in patients' lives, we encourage you to apply for this exciting opportunity. To learn more about our company, visit us at PromptCare In-home Respiratory and Infusion

Reports to: Departmental Lead, Supervisor or Manager

Job Type: Full-Time, 40 hours per week, Monday – Friday

Job Location: Fully Remote, or Hybrid schedule out of one of our office locations in New Providence, NJ and King of Prussia, PA

Requirements

• High School Diploma or equivalent
• Experience in medical office, patient contact and related experience
• Microsoft Office Suite experience
• Outbound calling experience required
• Excellent oral and written communication skills are required to communicate with colleagues, management, patients, and physician offices
• Medical Reimbursement background is preferred
  
  

Job Responsibilities, Included But Not Limited To

• Initiate new and concurrent authorization requests to insurance payers for Respiratory Therapy
• Submission of requests will be completed using paper forms, printed documentation, fax, payer portals or other means
• Completes follow-up on pending and or expired authorizations
• Review authorization approvals and denials for accuracy and initiate appeal process until the case is overturned, appeal options are exhausted, or a decision is made to discontinue the process
• Documents details of all calls, fax, and email communications in CPR+ per SOP of the department
• Maintains documented record of approved/denied authorizations in the patients’ chart for reference
• Maintains strict confidentiality and adheres to HIPPA guidelines and regulations
• Maintains a broad range of knowledge of insurance plan requirements, medical terminology, government regulation, and codes
• Escalate problem accounts and ensure resolution
• Regular contact with patients, insurance plans, physician offices, respiratory therapists and other personnel is necessary
• Timely follow-up and response for all quality reviews
• Work as a team player and share knowledge gained per insurance updates and communications with management and team members
• Other duties as assigned by Manager
  
  

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and listen. Requires the ability to lift files, open filing cabinets and bend or stand as necessary. This position may require the ability to occasionally lift office products and supplies weighing 20 pounds but no more than 35 pounds.

Benefits & Perks

• Competitive Salary
• Medical, Dental, Vision Package
• 401(k) plan (discretionary)
• PTO - Vacation, Sick and Personal days, and paid holidays
• Referral bonuses & Discount Ticket Program
• Lunch & Learn Programs
• Employee Recognition Program
  
  

Equal Employment Opportunity

The PromptCare Companies is committed to Equal Employment Opportunity (EEO) and prohibits employment discrimination on the basis of race, color, age, national origin, religion, gender, gender identity, sexual orientation, pregnancy, marital status, genetic disposition, disability, veteran's status or any other characteristic or classification protected by State/Federal/Local laws. We foster a work environment in which diversity and inclusion are embraced, people are hired and advanced on their merits, and employees are treated with mutual respect and dignity.