Authorization Specialist Job at RxFunction, Eden Prairie, MN

dmM1TTR1YnB5elo3dkttK0hWSWtWdDBiYVE9PQ==
  • RxFunction
  • Eden Prairie, MN

Job Description

Job Description

Job Description

Position Summary

The primary responsibility of the Authorization Specialist is to process prior authorization and appeal submissions for the Walkasins System per the requirements of third-party payers. Authorization Specialist will educate payers on the unique features and benefits of Walkasins. Communication with RxFunction sales team on status of authorizations will be key along with collaboration with other staff and departments within RxFunction when necessary. This role is hybrid in our Eden Prairie, MN office.

Job Responsibilities

Responsibilities include, but are not limited to, the following:

· Complete verifications of medical insurance plans and patient benefits with payers

· Review and verify required elements for a valid prescription and other order paperwork, per internal policy and payer guidelines.

· Review assigned denials for appeal filing information. Determining what is needed and obtaining additional documentation to support payer appeals.

· Initiate authorizations and appeals via phone, fax, or portals using patient specific insurance requirements to obtain coverage and payment for the Walkasins System.

· Track and perform timely follow up with payers to ensure resolution to pending authorization and appeal requests.

· Manage appeals that may require multiple levels of appeals including External Medical Review or phone hearings.

· Verify accuracy of authorization responses from payers.

· Enter and update authorization information for billing and auditing purposes.

· Process Walkasins approvals for shipment.

· Communicate to RxFunction sales team regarding authorization status.

· Handle patient information with discretion and maintain HIPAA compliance.

· Understand and comply with third party payer and Medicare rules and regulations.

· Other duties as assigned.

Required Qualifications

· Third party payer experience - minimum of two years experience.

· Extensive knowledge of medical insurance plan benefit information

· Strong written, verbal and interpersonal communication skills

· Strong critical thinking and problem-solving skills

· Detail oriented and the ability to manage competing priorities

· Ability to work independently as well as a team environment

· Proficiency in Microsoft Office software suite

· Flexible and ability to adapt to process and system changes as needed in a growing environment

Preferred Qualifications

· Associates degree or higher preferred

· 3+ years specific industry experience, preferably in health insurance and/or durable medical equipment

Physical Requirements:

· The physical demands described within the Responsibilities section of this job description 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.

· The employee is also required to use a computer and communicate with others.

Job Tags

Work at office, Flexible hours,

Similar Jobs

Panera

Talent Acquisition Manager (TAM) Job at Panera

 ...colleagues, and vendors. Self-motivated. Able to work independently and meet established deadlines, with strong...  .... Working Conditions: This is a work-from-home role and travel is up to 15%. Day and overnight travel, as needed, to perform talent acquisition duties... 

Marion County Senior Citizens, Inc.

Non-emergency Medical Transportation Driver Job at Marion County Senior Citizens, Inc.

 ...looking for a meaningful way to give back to your community, and earn a little extra money? Join our team at the Marion County Senior Citizens Center as a part-time Non-emergency Medical Transportation Driver and safely transport seniors to non-emergency medical appointments... 

SGS Consulting

Grounds Maintenance Job at SGS Consulting

 ...Setting up service setups for burial services. Installing memorials, digging, lifting, customer service requests and maintaining the grounds. Driver license is also needed for this position. Skills: ~ High School Degree or Equivalent Education/Experience: ~... 

Techware360

Remote Front-End Developer | Build Modern Web Apps Job at Techware360

An educational consultancy in Wayne, New Jersey, is seeking an entry-level Front-end Developer to code and design innovative web and mobile applications remotely. The role emphasizes efficient coding practices, backend data integration, and usability testing. Candidates... 

Great Wolf Lodge

Server Job at Great Wolf Lodge

Great Wolf Lodge, a leader in family resorts and entertainment, is looking for an enthusiastic Server to join our dynamic team at our indoor water park resorts. This position offers an enjoyable working environment in a vibrant setting aimed at providing families with...