Authorization Lead

Equal Opportunity Employer/Disability/Veterans Reliable Respiratory is a Durable Medical Equipment (DME) company that provides the highest quality level of service for patients in need of respiratory, diabetes, urology, and maternity support. Equipment provided includes, CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, CGM devices, insulin pumps, and breast pumps. Each patient is treated with professionalism, understanding, and attentive service. We care about our customers, work closely with the medical community, and have highly skilled staff ready to assist customers in receiving the best care possible. The Authorization Lead reviews all active rentals, and future claims, to assure proper documentation, prior authorization, patient eligibility, and compliance are met to achieve successful payment of claims. They will also be responsible for ensuring that the highest quality work is upheld, and the best practices are in place to ensure the department is performing optimally.

Duties and Responsibilities

• Provide exceptional service every time.
• Meet or exceed annual performance indicators as outlined by organizational leadership.
• Work with product line team to organize, coordinate and prioritize workflow.
• Provide leadership, support and guidance to team members.
• Understand and be able to perform, if necessary, department KPI reporting and team audits.
• Act as supervisor in place when leadership is not available or away
• Assist in training and developing all team members to perform all functions of their role in a proficient manner.
• Assist with performing patient account audits on team members every month.
• Serve as point person for patient and account escalations.
• Evaluate, resolve and/or escalate patient accounts that do not meet insurance or provider guidelines.
• Complete assigned tasks and worklists in a timely manner.
• Ensure scheduled dates of service for equipment rentals bill on time and correctly.
• Ensure supply orders can be placed and delivered to the patients when eligible for new supplies.
• Work with providers and patients to obtain necessary and current medical documentation.
• Stay up to date on insurance guidelines and their authorization and billing requirements.
• Ensure patient charts are up to date and accurate.
• Verify patients’ insurance eligibility, including contacting payors to investigate and verify the terms and benefits of patients’ insurance policies and costs.
• Facilitate process for requesting prior authorizations for Commercial, Medicaid, and Medicare Policies.
• Work with providers and patients to help them understand requirements for payor coverage including but not limited to:
• Authorization and compliance requirements
• Appeals for denied services / claims
• Process payment for services rendered.
• Troubleshoot equipment issues with patients.
• Refer issues to the Reliable clinical team, manufacturer’s care teams or referring provider as needed.
• Verify equipment scheduled to be returned or picked up, to ensure appropriate billing to patient and/or insurance.
• Actively participate in meetings as necessary.
• Perform other duties and special projects as assigned and directed.

Basic Qualifications

• 18 years of age or older
• Must be eligible to work in the United States and not require work authorization from us now or in the future
• High School diploma or equivalent required; college preferred
• At least 2 years of relevant (authorization, claims, billing) experience

Required Skills

• Effective leadership skills.
• Demonstrates effective problem solving.
• Ability to be a hands-on learner and performer.
• Efficient in problem resolution.
• Effective and professional verbal and written communication abilities.
• Listens attentively to people’ ideas and concerns.
• Makes decisions in a timely manner when the options are clear and there is little pressure or risk.
• Maintains balance through unexpected circumstances.
• Acts without being asked or required to do so.
• Exercises excellent judgment in all aspects of the execution of job duties.
• Effective and professional verbal and written communication abilities.
• Seeks to improve in all aspects of work performance.
• Responds to internal and external inquiries in a timely manner.
• Excellent customer service skills; especially in high intensity situations
• Strong attention to detail.
• Proficient in the use of computer applications (especially Microsoft Office Suite).
• Ability to work independently.
• Ability to work in collaboration with others.
• Ability to prioritize and complete work amidst interruptions in a busy work area.
• Ability to comply with internal and industry-imposed guidelines/regulations.

Competencies

• Leadership Skills
• Customer Service
• Strong Ethics
• Organization Skills
• Productivity
• Results Driven
• Computer Skills

Work Environment & 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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to communicate and convey information with the appropriate parties. The job requires assuming a stationary position for long periods of time
• This role routinely uses standard office equipment such as computers, phones, and printers/scanners

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

• This job operates in a professional office environment
• The noise level in the work environment is usually moderate to loud

Direct Reports – None

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Reliable Respiratory, INC participates in E-Verify. E-Verify is a web-based system that allows an employer to determine an employee's eligibility to work in the US using information reported on an employee's Form I-9. The E-Verify system confirms eligibility with both the Social Security Administration (SSA) and Department of Homeland Security (DHS). For more information, please go to the USCIS E-Verify website.