Prior Authorization Representative Jobs in Georgia

Description

Quipt Home Medical is a rapidly growing leader in the provision of clinical respiratory equipment and service in the durable medical equipment industry. We are looking for driven individuals to come grow with us.

Position: Customer Service Representative

Position Reports To 

Branch Manager/CSR Director

Position Summary

 As a Customer Service Representative, you are a direct point of contact for any patient, care giver, referral source, or commercial account that contacts Care Medical either in person, over the telephone or via the internet, to provide equipment and/or services. All CSSs are able to interact with customers to provide information in response to inquiries about products or services and to handle and resolve any complaints. A CSS is to receive, qualify, and process, according to procedure, all customer orders in a timely, efficient, accurate, and courteous manner. A CSS is often involved in investigating and responding to customer inquiries regarding shipments, products, deliveries and complaints.

Let's start with what's important to you. The Benefits.....

• Medical Insurance- multiple plans to choose from
• Dental & Vision Insurance
• Short Term Disability & Long Term Disability Options
• Life Insurance 
• Generous PTO plan
• Paid Holidays 
• 401K 
• 401K match
• Competitive Pay  

Essential Responsibilities:

Have a comprehensive understanding of the following:

• All products we carry
• Companywide Policies, Procedures, Standards, Specifications, Guidelines and Training Programs
• Basic Brightree Functions
• Proper Intake Procedures
• Insurance Verification and Eligibility
• CMN Requirements and Prior Authorizations
• Documentation Requirements of the Equipment
• Patient's Financial Responsibilities (Deductible, Co-Insurance, Co-Pay, ABN/Upgrade)
• Difference Between Verbal, Written and WOPD orders
• Complaint Resolution Procedures
• Answers the telephone using the company's professional greeting and taking complete, accurate and detailed messages. Transfers callers to appropriate person or voice mail number.
• Greets all visitors coming on their arrival. Ensure that they are properly directed to the appropriate personnel who might assist them.
• Distributes mail daily and monitors the fax machine for incoming transmissions. Distributes correspondence to appropriate personnel or mailbox depending on the priority of the correspondence.
• Qualify orders by identifying the customer's diagnosis and insurance coverage and ensure verification of the necessary insurance reimbursement information to process the third party billing when appropriate. Informs customers of financial responsibility.
• Inputs customers' orders or changes into the computer system timely. Processes work order and necessary paperwork as well as prescriptions for physicians.
• Arranges for convenient customer delivery/pickup time with patient and/or caregivers. Conveys orders to Clinical Specialists and/or delivery personnel.
• Handles customer complaints courteously using appropriate techniques, problem solving skills and follow-up logs.
• Audits, confirms and files all deliveries, pick-up or exchange paperwork daily. Reviews various edit reports to assure accuracy.
• Tracks active rentals, automatic reorders, and concentrator maintenance, processing in a timely as per policy and procedure.
• Obtains appropriate prior authorization number and time frame from appropriate third party payer. Logs information into database.
• Obtains verbal and written orders from physicians, discharge planners and other healthcare professionals as needed.
• Ensure that all assigned procedures, including but not limited to, billing, posting, insurance, denials, inquiries, orders, and paperwork are processed in an accurate and timely manner.
• All patient files and information are maintained and current at all times.
• Participates in company training programs
• Demonstrates excellent oral and written communication skills with referrals, handling complaints and qualifying orders.
• Timely filing of all necessary paperwork into patient charts.
• Assist in working various computer reports for quality assurance.
• Instruct the customer or caregiver in the proper and safe use of all equipment delivered in the store and provide each customer with the appropriate PIC sheet or other instructional material. Obtain required signatures and provide customers with a copy of the signed Delivery and Customer Information Checklists.
• Strict adherence to all company policies and procedures.
• Performs schedules hours, staggered shifts in accordance to the needs of the company.
• Perform all above duties in other company locations when required.
• May perform other duties not specifically listed in this position description as assigned by supervisor.
• Continually strive to develop your knowledge and skills in all areas of your job.

Requirements

Position Qualifications

• High School Diploma or equivalent
• Previous experience in a Clerical or Customer Service environment
• Knowledge of Microsoft Office (Word, Excel) etc.
• Proficient general office skills (typing, computer, fax, filing, multiple phone line)
• Neat personal appearance with pleasing manner and interpersonal skills Strong communication skills with capacity to make independent decisions Medicare/Medicaid and insurance billing, bookkeeping or medical office experience preferred

Continuing Education

As designated by management to include company in services and off-site training programs as appropriate to industry and position.

FLSA Status

Non-Exempt

Licenses, etc.

None