DME Authorization Specialist

The HME Specialist will serve as a critical member of the Giving Home Medical Equipment patient service team, specializing in the Prior Authorization Management. As part of the HME Operations Team which compiles, submits, and manages all Prior Authorization requests to the Dept of Labor. #INDTX/CO

Responsibilities: Prior Authorization Management:

Submit a high volume of complete and verified Authorization Packets working from multiple task and priority lists.

Manage Payor Portal Authorization updates and communicate these updates to team members.

Update Patient Records appropriately based on Authorization responses. Update Salesforce and Brightree appropriately based on Authorization responses to direct actions to team members.

Complete tasks and Authorization requests promptly and within allowable timelines.

Scanning of mailed responses from Payors into Brightree and Salesforce systems and communicating responses to team members.

Payor Communication:

Place calls to DOL Medical Benefits Examiners to determine the reasoning behind Authorization processing decisions.

Receive calls from DOL Medical Benefits Examiners regarding questions for submitted Authorization Requests.

Communicate effectively and professionally with Payor representatives to ensure appropriate processing of Authorization Requests.

Compliance and Communication:

Communicate with patients/care team members/DOL via inbound and outbound phone calls.

Act as a liaison between patients, Home Health teams, clinicians, and payers to ensure seamless communication and service delivery.

Perform Other Duties as Necessary:

Assist GivingHME as a whole by performing additional duties and responsibilities as necessary to provide the best care possible for patients.

Qualifications: High school diploma or GED required; Associate’s or Bachelor’s degree in a healthcare-related field preferred.

Minimum 3 years of experience in a DME business environment, healthcare administration, preferred.

Familiarity with DOL, DEEOIC, and private insurance billing processes is a plus.

Skills and Competencies: Deep and instinctual understanding of Durable Medical Equipment and Home Medical Equipment. Its use, functions, and care.

Excellent communication and customer service skills. Strong and kind phone presence.

Detail-oriented with strong organizational and time management abilities.

Brightree Experience

Salesforce experience.

Strong time management skills.

Work Environment and Physical Requirements: May require standing, sitting, or lifting equipment up to 50 pounds.

Must be able to work collaboratively in a fast-paced, compliance-focused healthcare environment.

Benefits: • Health, Dental, and Vision Insurance after 30 days

• 401(k) with company matching program

• PTO, holidays, and your birthday off

• Company holidays, floating holiday, and birthday holiday

• Vacation (PTO) and Sick Days

• Company-paid STD and LTD

• Tuition reimbursement program

• $100 monthly cell phone reimbursement

• Monthly in-office lunch for birthdays, anniversaries, and events.