Job Description

Position Summary

The primary responsibility of the Authorization Specialist is to process prior authorization and appeal submissions for the Walkasins System per the requirements of third-party payers. Authorization Specialist will educate payers on the unique features and benefits of Walkasins. Communication with RxFunction sales team on status of authorizations will be key along with collaboration with other staff and departments within RxFunction when necessary.

Job Responsibilities

Responsibilities include, but are not limited to, the following:

· Complete verifications of medical insurance plans and patient benefits with payers

· Review and verify required elements for a valid prescription and other order paperwork, per internal policy and payer guidelines.

· Review assigned denials for appeal filing information. Determining what is needed and obtaining additional documentation to support payer appeals.

· Initiate authorizations and appeals via phone, fax, or portals using patient specific insurance requirements to obtain coverage and payment for the Walkasins System.

· Track and perform timely follow up with payers to ensure resolution to pending authorization and appeal requests.

· Manage appeals that may require multiple levels of appeals including External Medical Review or phone hearings.

· Verify accuracy of authorization responses from payers.

· Enter and update authorization information for billing and auditing purposes.

· Process Walkasins approvals for shipment.

· Communicate to RxFunction sales team regarding authorization status.

· Handle patient information with discretion and maintain HIPAA compliance.

· Understand and comply with third party payer and Medicare rules and regulations.

· Other duties as assigned.

Required Qualifications

· Third party payer experience [minimum 7- 10 years] with direct interaction with payers

· Extensive knowledge of medical insurance plan benefit information

· Strong written, verbal and interpersonal communication skills

· Strong critical thinking and problem-solving skills

· Detail oriented and the ability to manage competing priorities

· Ability to work independently as well as a team environment

· Proficiency in Microsoft Office software suite

· Flexible and ability to adapt to process and system changes as needed in a growing environment

  Preferred Qualifications

· Associates degree or higher preferred

·3+ years specific industry experience, preferably in health insurance and/or durable medical equipment

Physical Requirements:

· The physical demands described within the Responsibilities section of this job description are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

· The employee is also required to use a computer and communicate with others.

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