HME Authorization Specialist

Responsibilities:

• Coordinate with internal Giving Home Medical Equipment, Home Health Care, and external referral sources to collect and verify patient information and medical documentation.
• Manage Document transfers from software platforms to organize patient documents appropriately.
• Communicate with internal and external team members when necessary for retrieval of documentation from physician offices.
• Scanning of mailed responses from Payors into Brightree and Salesforce systems.
• Verify appropriate coding, cost, frequency and duration of requested Medical Equipment using Brightree. 
• Compile Prior Authorization packets and submit them through Payor Portals.
• Manage Payor Portal Authorization updates and communicate these updates to team members.
• Update Patient Records appropriately based on Authorization responses.
• Update Salesforce and Brightree appropriately based on Authorization responses to direct actions to team members.
• Monitor Authorization steps taken to ensure timeliness and compliance.
• Complete tasks and Authorization requests promptly and within allowable timelines.
• Place calls to DOL Medical Benefits Examiners to determine the reasoning behind Authorization processing decisions.
• Receive calls from DOL Medical Benefits Examiners regarding questions for submitted Authorization Requests.
• Communicate effectively and professionally with Payor representatives to ensure appropriate processing of Authorization Requests.
• Collaboration with HME Operations and Billing Departments
• Assist HME Operations with the monitoring and working of reports to facilitate Prior Authorization needs.
• Collaborate with Billing Departments for Pricing/Fee Schedule Updates.
• Collaborate with HME and Home Health departments as necessary.
• Communicate with patients/care team members/DOL via inbound and outbound phone calls.
• Act as a liaison between patients, Home Health teams, clinicians, and payers to ensure seamless communication and service delivery.
• Perform Other Duties as Necessary
• Assist Giving HME as a whole by performing additional duties and responsibilities as necessary to provide the best care possible for patients.
 

Qualifications:

• High school diploma or GED required; Associate’s or Bachelor’s degree in a healthcare-related field preferred.
• Minimum 3 years of experience in a DME business environment perferred.
• Familiarity with DOL, DEEOIC, and private insurance billing processes is a plus.
 

Skills and Competencies:

• Deep and instinctual understanding of Durable Medical Equipment and Home Medical Equipment.  Its use, functions, and care.
• Excellent communication and customer service skills.  Strong and kind phone presence. 
• Detail-oriented with strong organizational abilities.
• Brightree Experience
• Salesforce experience.
• Strong time management skills. 
 

Work Environment and Physical Requirements:

• Office-based, on-site role.
• May require standing, sitting, or lifting equipment up to 50 pounds.
• Must be able to work collaboratively in a fast-paced, compliance-focused healthcare environment.