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SalaryThe Insurance Verification and Authorization Specialist (Rehab Support) plays a crucial role in ensuring the smooth and efficient processing of insurance coverage for Complex Rehab equipment. They are responsible for verifying insurance policies, obtaining necessary documentation, and submitting authorization requests. The specialist must accurately enter orders into the management software, generate required insurance forms, and maintain clear communication with patients, physicians, and internal stakeholders.
Key Responsibilities:
Verify Insurance Coverage: Conduct thorough insurance verifications to determine the extent of coverage for Complex Rehab equipment. Ensure the necessary Rehabilitation Authorization Certificate (RAC) form has been received.
Order Entry and Documentation: Accurately enter orders into the management software using quotes provided by the appropriate Assistive Technology Professional (ATP). Generate insurance forms or cash pay quotes as required by specific insurance providers. Collect required documents such as Letters of Medical Necessity (LMN) from physicians for coverage and submission to payers.
Documentation Compliance: Review medical documentation to ensure that all equipment components are justified and properly supported. Request addendums for missing information and coordinate with healthcare providers to gather necessary details.
Financial Management: Maintain a balance between patient needs and the company's financial requirements. Obtain the appropriate profit margin or communicate equipment upgrades to patients. Notify and collect necessary co-insurance and non-covered items prior to ordering or delivery, once payer resources have been established.
Prior Authorization and Authorization Tracking: Submit prior authorization requests when required and maintain a comprehensive log of authorization status and dates received. Ensure timely communication with patients and ATPs regarding the approval process.
Patient Communication and Correspondence: Handle communication with patients as required, addressing their inquiries, concerns, and providing updates on insurance verification and authorization status. Document all correspondence accurately in the patient notes within the management software.
File Management and Follow-up: Perform weekly follow-ups on documentation and correspondence to ensure files move through the system efficiently without compromising service timeliness. Collaborate with internal teams, including ATPs and management, to address any held billing as a priority to ensure prompt claim submission.
Continuous Improvement: Provide valuable input to management regarding process improvement opportunities and workplace function enhancements.
Regulatory Compliance: Strictly adhere to all HIPAA, Joint Commission, and Compliance rules and regulations while handling sensitive patient information and documentation.
Additional Duties: Perform other assigned duties as necessary to support the smooth functioning of the department and organization.
High School diploma or GED required.
Previous experience in health insurance and authorization is preferred.
Knowledge of reimbursement procedures and ability to interpret medical terminology.
Proficient computer skills in word processing and databases.
Ability to effectively communicate with employees, customers, and referral sources.
Competency in operating relevant management software for the scope of the job description.
Note: Compensation will be determined based on the candidate's experience level.
