Prior Authorization Specialist / MA, LPN, RN

Job Description

Job Description

Salary : $20-$30 Hourly DOE

Prior Authorization - Escalation Specialist & Team Leader

Company Overview :

Mountain Medical Supply (MMS) is a national durable medical equipment (DME) company dedicated to providing top-quality medical equipment and supplies to former U.S. Department of Energy workers (and their families) who became ill due to toxic and radiological exposures at covered Department of Energy facilities. Our mission is to help these individuals achieve the best possible quality of life through reliable, compassionate service.

We are looking for an MA, LPN, RN with clinical experience. The Authorization Escalation specialist and Team Leader are responsible for the successful completion of prior authorizations for Medical Equipment including Escalated Authorization Cases. This process requires high levels of organization, dedication, and persistence . The position serves as an advocate for patients to obtain approvals for their Durable Medical Equipment through the Department of Labor, working at an elevated level and helping maintain workflow for the authorization specialists. This person must have the ability to problem-solve independently, able to address and resolve confrontation, and oversee daily functions of the authorization team, act as a authorization area float, as well as work and manage the escalated authorization requests. This position will work closely with medical benefit examiners at the DOL, case managers, patients, and all internal departments.

Key Responsibilities

• Writing letters of medical necessity.
• Comfortable with talking on the phone.
• Comfortable working daily with insurance payers to gain prior authorization approval.
• Comfortable working with remote teams in multiple states.
• Understands and accurately applies requirements for prior authorization.
• Ensures eligibility and benefits are properly verified.
• Exhibits excellent customer service skills and serves as an advocate for the patient.
• Performs other related duties as assigned or requested in order to maintain a high level of service.
• Demonstrates professional work behavior by following Service Standards and Success factors.
• Complies with departmental organizational policies and procedures and adheres to external agency requirements.
• Ensure compliance with coding and billing regulations, including HIPAA and other industry guidelines.
• Maintain accurate and up-to-date documentation of job-related activities, including authorizations, claims, appeals, and communication internally and externally.

Required Knowledge and Skills

Education / Licensure / Technical Requirements.

Details and Benefits :