RespirTech helps improve the quality of life for patients with a variety of chronic respiratory conditions (such as Cystic Fibrosis and chronic COPD-associated breathing conditions like bronchiectasis) or conditions resulting from neuromuscular disorders by managing airway secretion clearance.
RespirTech employees enjoy the opportunity to learn, grow, and make an impact. You can be a part of a team with a passion and purpose that offers innovative, reliable products to our patients.
The Insurance Specialist is responsible for procuring payment sources for all orders by verifying benefit coverage for all levels of insurance, initiating initial authorizations, re-authorizations and/or letters of agreement with insurance payers, following-up on submitted initial authorizations, re-authorizations and/or letters of agreement and resolving and/or assisting the appeals team in resolving authorization denials.
Duties and Responsibilities
- Develop and maintain working knowledge of current durable medical equipment (DME) products offered by the company and all applicable insurance guidelines as it relates to eligibility for coverage and reimbursement
- Perform in-depth insurance benefit verification with all payer sources to ensure maximum payment for services provided and determine risk of shipping prior to obtaining an authorization
- Responsible for creating, submitting and following-up on all initial authorizations, re-authorizations and/or letters of agreement in the manner and time frame required by departmental policy and procedure and/or the insurance payer
- Coordinate with internal and external customers to obtain all information needed, based on medical criteria from the insurance payer, from healthcare teams and customers to obtain authorization from the insurance payer
- Responsible for resolving authorization denials and/or assisting the appeals team in resolving authorization denials
- Ensure insurance related tasks are performed accurately, efficiently, and timely to meet department and company goals
- Function as the primary expert to explain patient insurance benefits to internal and external customers
- Handle incoming and outgoing calls from internal team members, insurance payers and customers related to insurance benefits and authorizations
- Collaborate with external and internal team members and customers to create a remarkable experience for our customers, maximize reimbursement and business opportunities
- Cross train within the department to ensure smooth work flow and functional coverage
- Report recurring payer issues or changes to the Insurance Supervisor
- Participate in department meetings
- Attends HIPAA training and other training sessions as required
- Understand and comply with all applicable company policies and procedures
- Comply with all applicable local/state/federal regulations related to the medical device and durable medical equipment industries
- Perform other related duties as directed by supervisor
- 2 or 4 year college degree in business or healthcare related field or equivalent work experience
- 2+ years’ experience working for or with medical insurance companies in a healthcare setting, preferably in verifying insurance eligibility and benefit limits and/or submitting and receiving prior authorizations for service
- Durable Medical Equipment (DME) experience preferred
- Demonstrated superior customer service skills
- Excellent communication skills, both verbal and written
- Strong analytical and problem solving skills
- Ability to organize and prioritize workload
- Ability to work independently and as part of a team
- Strong computer skills, including proficiency in word processing and spreadsheet software
Physical Requirements of the Position:
Candidate must be able to sit at a desk in front of a personal computer (PC) monitor for long periods of time. Position requires incumbent to use a PC, telephone, and basic office equipment. This position requires the candidate have the ability to conduct telephone conversations, read medical and insurance information and communicate clearly with all internal and external customers.
If you are interested in applying for this opportunity at RespirTech, please complete the online application and upload your resume in a .word or .pdf format. Thank you for your interest!