ABC Home Medical Supply, Inc is one of the nation's leading urological supply providers and serves as a one-stop shop with a comprehensive line of medical supplies and service that includes: Urological, Incontinence, Wound Care, and Ostomy. ABC Medical is part of the JDS, Inc family of businesses. Our service companies possess the knowledge and expertise to deliver first-class products and personalized home healthcare services.
Location: Port Saint Lucie
Department:
Work Location: Port Saint Lucie, FL
Hybrid - Onsite Monday & Tuesday
Work Hours: 8:30am-5pm EST
Responsibilities:
The Referral Specialist is responsible for verifying, obtaining, reviewing, and accurately determining that all medical documentation received from physicians or referral sources meets all Local Coverage Determinations and regulatory requirements. The Referral Specialist is responsible for the pre-authorization functionality.
- Perform insurance eligibility verification utilizing various methods including portals and phone calls to confirm insurance coverage and eligibility of products. Obtain required documentation with regular communication via phone and fax to offices.
- Examine received documents to verify required compliance, completeness, and accuracy of data.
- Confer with Physician/Provider offices and approvers to resolve identified discrepancies and ensure that the needed documents support the services we are providing.
- Request/Submit and follow up for Prior Authorizations (PARs) and PCP referrals.
- Generate communication to the appropriate personal on new and revised documents including Prescriptions and Pre-authorization request.
- Regularly communicate with Territory Manager's Physician/Providers, Payors, and internal departments.
- Update customer database with detailed plan information when obtaining insurance policy information.
- Appropriately update customer database when obtaining Prescriptions, office notes, pre-authorizations, and other documents.
- Notate all customer accounts with all actions taken in clear and detailed language.
- Communicate Payor requirements as they are discovered.
- Achieve defined SLA's.
- Quickly assess situations and respond appropriately; handle special requests in a sensitive, professional manner.
Minimum Qualifications:
- High School Diploma or equivalent work experience
- Basic understanding of payor guidelines which includes reading, understanding and interpreting medical records, payor requirements etc
- 2+ years of work experience in insurance verification/referrals
- Working knowledge of Microsoft Office suite, including working within Excel tabs and analyzing information
- Strong multitasking, attention to detail, organizational and communication skills (written and verbally)
- Working knowledge of all HIPAA guidelines/regulations and adherence to them
- Ability to work well in a team environment
Preferred Qualifications:
- Previous DME experience a plus
- Medical Assistant Experience
Here's what we have to offer:
- Variety of Medical, Dental and Vision Insurance Plans
- 401k Plan with Company Match
- PTO and Paid Holidays
- EAP
- Employee Discounts
Job Req ID: 33298
EOE Statement:
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
Accommodations Statement:
ABC Medical endeavors to make www.abc-med.com accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the ABC Medical HR Department at [email protected]. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.
What We Do
Hollister Incorporated is an independent, employee-owned company that develops, manufactures, and markets healthcare products and services worldwide. Our Mission is to make life more rewarding and dignified for people who use our products and services. Throughout the company, there is the recognition that Hollister is unique, not only as an independent, employee-owned company but also in its Mission and its commitment to the principles on which the company was founded.
Through a shared affirmation that every human being has dignity and intrinsic value, the focal point of everything we do at Hollister is people. At Hollister, we realize that each person who uses our products and services is on a distinct, and often challenging, life journey. In every aspect of what we do, the overriding goal and commitment is to make a difference in that journey.
The principle of Dignity means that we respect all people, independent of the work they do, their age, their color, their gender, or their nationality.
Integrity is at the heart of how we do business at Hollister, and throughout the company, there is an unwavering conviction that the ethical way is the only way to conduct our business.
The principle of Service, to our customers and to each other, inspires us to strive for unconditional customer satisfaction; serving with humility, compassion, and perseverance.
The principle of Stewardship inspires Hollister Associates to act as guardians of the company – ensuring that Hollister will continue to be independent, employee-owned, and faithful to its Mission of making a sustained and meaningful difference in the lives of people around the world.
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Medical devices sold in the EU are marked with CE symbol or CE 0050 symbol as appropriate. For more information, see www.hollister.com.
