Prior Authorization Specialist

**Prior Authorization Specialist** Since our doors opened in 1989, Reliable Medical has been committed to improving the lives of all who entrust us with their care and those who we entrust to provide it. We strive to be the premier provider of complex mobility solutions and other critical services for customers seeking compassionate care and optimal outcomes. Our mission is to improve the lives of those we serve by providing best in class service to customers, education, product expertise and dedicated partnership to clinicians, and development, careersatisfaction and work-life balance to our team members. We aspire to bring our mission to new communities and to reinvest our growth into improving lives, treating one another and our customers, like family. **Brief description** The Prior Authorization Specialist plays a crucial role in ensuring that patients receive timely access to necessary home medical equipment. This position involves meticulously reviewing medical documentation, preparing pre-authorization requests, and communicating with insurance providers to secure approvals. The specialist must navigate complex billing codes and insurance requirements while working collaboratively with various departments to provide seamless patient care. **Essential Functions** - Review diverse medical documentation and prepare pre-authorization requests for a variety of home medical equipment. - Follow up with insurance providers on submission statuses to secure timely approvals and manage any denials effectively. - Initiate and manage appeals for denied authorizations, exploring every possibility for patient approval. - Utilize various methods for pre-authorization submissions, including fax, phone, email, website portals, and other communication channels. - Develop proficiency in HCPC billing codes, medical terminology, and interpreting complex chart notes for accurate processing. - Understand the specific requirements of each insurance company and navigate the intricacies of submitting pre-authorization requests for each provider. - Collaborate within a high-paced team environment to ensure timely provision of crucial equipment for patients. - Communicate effectively and professionally with insurance companies, sales representatives, the billing department, and team members to streamline the authorization process. - Perform other duties as assigned by management. **Qualifications and requirements** - High School Diploma or equivalent. - Prior work experience in a professional office environment is essential. - Previous experience in Prior Authorization and/or Durable Medical Equipment (DME) is mandatory. - Working knowledge of durable medical equipment is advantageous. - Proficiency in basic computer skills, including Microsoft Office Suite (Outlook, Word, Excel, SharePoint, etc.). - Exceptional interpersonal skills for building rapport and maintaining professional relationships with various stakeholders. - Highly self-motivated, with the ability to work both independently and collaboratively within a team. - Strong verbal and written communication skills, with a keen eye for detail and accuracy. **Competencies** - Detail-oriented and thorough in reviewing medical documentation and processing requests. - Strong analytical skills for interpreting complex chart notes and billing codes. - Proactive and persistent in following up with insurance providers and managing denials. - Effective communication and interpersonal skills for interacting with various departments and external stakeholders. - Ability to work efficiently in a high-paced team environment. - Problem-solving skills for managing appeals and finding solutions for denied authorizations. **Physical Requirements** - Ability to work at a computer for extended periods. - Effective use of office equipment such as telephones, computers, and fax machines. - Occasional lifting of office supplies and medical documentation files. **Our Commitment to you:** - **Work-Life Balance and…