LymphaCare, a leading provider of top-of-the-line products for treating wounds and lymphedema, is looking for an experienced Prior Authorization Specialist.
Job Duties
Develop and maintain working knowledge of current products and services offered by the company.
Review all required documentation to ensure accuracy.
Maintains an extensive knowledge of different types of payer coverage and insurance policies.
Responsible for verifying patient insurance coverage, to ensure necessary procedures are covered by the individual’s insurance accurately.
Complete insurance verification to determine patient’s eligibility, coverage, co-insurances, and deductibles.
Obtain authorization from insurance carrier
Resolves any issues with authorizations and escalates complicated issues to a supervisor/manager.
Responsible for entering data into Brightree. Including payer information, authorizations and coverage limitations.
Position requires staff to spend majority of time on the phone or on payer websites
Must be able to navigate through multiple online EMR systems to obtain applicable documentation.
Communicate with management on an on-going basis regarding any noticed trends with insurance companies.
Responsible for communicating when documentation received does not meet payer guidelines.
Meet quality assurance requirements and other key performance metrics.
Pays attention to detail and has great organizational skills.
Flexible with the actual work and the hours of operation
Utilize company provided tools to maintain quality. Some tools may include but are not limited to Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI (National Provider Identifier), PECOS (the Medicare Provider Enrollment, Chain, and Ownership System) and “How-To” documents
Competency, Skills and Abilities
DME Experience preferred
Brightree Experience preferred
Excellent customer service skills
Analytical and problem-solving skills with attention to detail
Decision Making
Excellent ability to communicate both verbally and in writing.
Ability to prioritize and manage multiple tasks.
Proficient computer skills and knowledge of Microsoft Office
Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.
General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements.
Work well independently and as part of a group.
Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.