Quality Control Prior Authorization Specialist
Diabetes Supply Omaha, NE
- Posted: over a month ago
- Benefits: dental, life_insurance, medical, vision, 401k
A. JOB SUMMARY:
Patients rely on us to promptly deliver their medications, equipment and supplies without hassle. Our quality control team works with patient providers to ensure we have the proper documentation to supply our patients in a timely manner. Employees at Diabetes Supply must uphold our core values: patient- centric, driven, team player, smart working, and always improving.
Within this fast-paced team environment, you will be responsible for using various resources to gather medical documents, manage inbound and outbound document flows, submit authorizations, work with multiple insurance companies, and check patient major medical and pharmacy benefits. This team has constant communication with providers, insurance companies, and the resupply department, and must be able to meet deadlines, multi-task, and work under pressure.
The Quality Control Specialist reports directly to the Quality Control Manager.
B. ESSENTIAL JOB FUNCTIONS:
· Obtain needed documentation from providers
· Obtain authorizations from insurance companies
· Manage company-wide inbound documents via fax and review lists
· Work with insurance companies to determine benefit levels
· Contribute to the team-based environment by encouraging others and identifying opportunities for improvement
· Continue to learn and adapt to new processes within the company
· Upkeep knowledge of current insurance company guidelines and requirements
· Maintain current knowledge, understanding and compliance with company guidelines as published in the employee handbook.
· Maintains client/patient confidentiality in accordance with HIPAA requirements.
C. JOB SPECIFICATIONS:
· One year of Customer Service job experience; healthcare preferred.
· High School diploma or equivalent.
· Knowledge of health insurance preferred, but not required
D. PHYSICAL REQUIREMENTS:
Seeing: Must be able to read reports and use computer.
Hearing: Must be able to hear well enough to communicate with co-workers. Must be able to wear a wireless headset to answer calls.
Manipulate/Grasping/Feeling: Must be able to write, type and use phone system.
E. WORKING CONDITIONS:
This job will be primarily remote. Computer and office supplies provided. The employees will need to provide a professional working space and appearance for virtual meetings.
This job is in support of our patient needs and will be scheduled accordingly. Individual schedules may vary throughout the week based on staffing and business needs. May require some overtime and weekends.
G. UNDERSTANDING AND ACCEPTANCE:
I understand and agree with the above job description. I have the ability to perform the essential functions of this position either with or without a reasonable accommodation. The position, the reporting relationship and a copy of this job description have been provided to me.
- Chosen by Manufacturers
- Recommended by Providers
- Preferred by Customers
- Valued by Communities
We are in-network with most major insurances and hold pharmacy licenses in: Arkansas, Colorado, Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Oklahoma, South Dakota, Utah, Wisconsin & Wyoming.
Diabetes SupplyWhy Work Here?
Amazing, innovative, forward thinking, open to ideas culture who cares about offering their people a place to think, give and grow.
Diabetes Supply helps individuals on their journey toward diabetes self-management. We care for patients by providing durable equipment, supplies and medications. Our focus is to be: - Chosen by Manufacturers - Recommended by Providers - Preferred by Customers - Valued by Communities We are in-network with most major insurances and hold pharmacy licenses in: Arkansas, Colorado, Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Oklahoma, South Dakota, Utah, Wisconsin & Wyoming.
2910 South 84th StreetOmaha, NE