Reauthorization Specialist - Full Time - Remote & Hybrid Flexible

Job Type
Full-time
Description
PromptCare is a leading provider of home respiratory and infusion services, serving pediatric and adult patients in 30+ states from 36 locations throughout the United States. Our Hi-Tech, Hi-Touch care offerings deliver superior patient care and outcomes making PromptCare a preferred partner for hospitals, physicians, and payors. PromptCare currently services 6,400+ respiratory patients, 2,500+ infusion patients, and 4,400+ enteral nutrition patients. We estimate that we are the largest provider of ventilation care to pediatric patients in the U.S. Our mission is to be the preferred choice for superior management of complex cases, providing unsurpassed clinical expertise, reliable service, and boundless compassion in transitioning patients to the home setting and reuniting them with their loved ones. Our Differentiation consists of an unrivaled team of respiratory therapists, nurses, dietitians, pharmacists, and other care professionals who provide highly sought-after expertise, advice, and patient care. We are the “go-to” provider in our markets among leading pediatric hospitals and care facilities to handle the most acute patient situations. PromptCare holds an expansive payer network participation, supported by a robust billing & collections operation.
PromptCare is looking for a Reauthorization Specialist to join our Intake Department. This is a full-time position, 40hrs per week. Mon-Fri
Job Summary
The position will entail the timely submission of authorization requests to assigned payers. Submission of requests will be completed using paper forms, printed documentation, fax, payer portals or other means. Complete follow up on requests to ensure timely turnaround and approval. Understand payer requirements to ensure approval is granted. Escalate problem accounts and ensure resolution. Regular contact with patients, insurance plans, physician offices, respiratory therapists and other personnel is necessary.
Requirements

• Medical Reimbursement background is preferred.
• High School Diploma or equivalent.
• Excellent oral and written communication skills are required to communicate with colleagues, management, patients, and physician offices.
• Microsoft Office Suite experience.
• Experience in medical office, patient contact and related experience.

Job Responsibilities, Included But Not Limited To

• Documents details of all calls, faxed, and email communications in CPR+ per SOP of the department.
• Maintains strict confidentiality and adhere to HIPPA guidelines and regulations.
• Maintains a broad range of knowledge of insurance plan requirements, medical terminology, government regulation, and codes.
• Completes follow-up on pending and or expired authorizations.
• Initiate new and concurrent authorization requests to insurance payers for Home Infusion Therapy.
• Maintains documented record of approved/denied authorizations in the patients’ chart for reference.
• Timely follow-up and response for all quality reviews.
• Other duties as assigned by Intake Manager.
• Work as a team player and shares knowledge gained per insurance updates ad communications with management and team members.
• Review authorization approvals and denials for accuracy and initiate appeal process until the case is overturned, appeal options are exhausted, or a decision is made to discontinue the process.

Physical Demands
Lifting, Carrying, Pushing and Pulling
Benefits & Perks

• Competitive Salary
• 401(k) plan (discretionary)
• Lunch & Learn Programs
• Medical, Dental, Vision Package
• Referral bonuses & Plum Benefits Discount Ticket Program
• Employee Recognition Program
• PTO - Vacation, Sick and Personal days, and paid holidays

Equal Employment Opportunity
The PromptCare Companies is committed to Equal Employment Opportunity (EEO) and prohibits employment discrimination on the basis of race, color, age, national origin, religion, gender, gender identity, sexual orientation, pregnancy, marital status, genetic disposition, disability, veteran's status or any other characteristic or classification protected by State/Federal/Local laws. We foster a work environment in which diversity and inclusion are embraced, people are hired and advanced on their merits, and employees are treated with mutual respect and dignity.