Authorization & Benefits Specialist

About the job

People Purpose: Beyond Competitive

It is no longer ok to just be competitive regarding how we treat our people in everything we do. Our leadership team believes wholeheartedly we need to be beyond competitive and cultivate a culture of proud, driven employees who are passionate about the work they do and where they do it. Our leadership strives to unleash unsurpassed potential in every team and individual employed and owns making that happen. Sincere, Simple, Smart.

What makes us Beyond Competitive:

• 6 weeks’ time off annually
• Employee bonus plan
• Flexible hybrid/remote work options
• Full pay maternity, paternity, parental, short-term disability leaves
• Employee driven recognition program
• Access to hundreds of training opportunities
• Company paid educational assistance
• Well-being on demand
• Perks at Work
• Competitive health and welfare plans -HSA company contribution
• 401(k) company match
• Great culture and people!

The Opportunity:

The Authorization & Benefits (A&B) Specialist is responsible for submitting and monitoring continuation-of-care authorizations, as well as obtaining new authorizations when insurance changes occur for existing patients ensuring uninterrupted SmartVest therapy and preventing delays in billing. The A&B Specialist serves as a liaison between patients, healthcare providers, and insurance companies by verifying benefits, submitting timely re-certification requests, and efficiently managing both approval and denial outcomes. Excellent communication skills and exceptional attention to detail are critical for success in this role. This is a full-time, remote position.

Job Outcomes You Must Get:

• Follow Electromed mission and core values, while striving to achieve company goals
• Understand and adhere to local State and Federal healthcare regulatory and compliance rules
• Review documentation for updated patient demographics, insurance information, prescription requirements, and medical records per payer guidelines
• Verify insurance eligibility and DME benefits
• Comprehensively navigate payer websites
• Competently communicate with payers, clinics, PCP’s
• Effectively submit insurance requests to obtain authorization(s) and referrals
• Communicate effectively with Reimbursement Team, such as Patient Account Liaisons and Patient Services
• Educate patients on complex reimbursement situations
• Accurately record information to internal Patient Database
• Complete other miscellaneous tasks as needed to help support the reimbursement team
• Handle denied recertifications in a timely manner by obtaining needed documentation and forwarding to the Appeals Team

Job Outcomes Requirements:

• High School diploma or GED required; degree preferred
• Experience working with insurance companies in the capacity of benefits, coverage, and authorizations
• Experience working directly with third party or government payers
• Experience with medical terminology
• Knowledgeable of insurance requirements and can determine medical justification to ensure proper reimbursement
• Knowledge of Microsoft Office suite
• High attention to detail and accuracy with the ability to handle multiple priorities
• Self-starter, motivated, team-player
• Excellent written and verbal communication skills
• Demonstrated exceptional customer service skills
• Ability to prioritize and organize
• Strong analytical and problem-solving skills
• Active participant of continuous improvement