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Sleep Therapy Prior Authorization Specialist
3 months ago
The Opportunity
Within Aeroflow, the Sleep Billing Team is currently composed of 15 team members. The main focus of the team is to collect outstanding debt from health insurance or patients. The patients that we serve are patients that receive continuous positive airway and non-invasive ventilation equipment and supplies from Aeroflow Sleep.
Sleep Billing is unique in that we have 3 teams within the one. One team consists of Patient Advocates who are the face of Aeroflow Sleep Billing. The second team is composed of junior and senior insurance specialists (billers), and the third team is our Prior Authorization team.
Your Primary Responsibilities
Prior Authorization Processing:
- Review requests for sleep therapy services and equipment to determine the necessity of prior authorization.
- Collect patient information, including medical history, insurance details, and prescribing physician information.
- Verify insurance coverage and understand specific requirements for prior authorization from different payers.
- Initiate prior authorization requests through appropriate channels, following established procedures and guidelines.
- Monitor the status of prior authorization requests and follow up as needed to expedite approvals.
- Maintain accurate records of prior authorization requests, approvals, denials, and appeals.
- Ensure all required documentation, such as sleep study reports, physician prescriptions, and medical necessity documentation, are complete and submitted correctly.
- Organize and maintain patient and insurance information securely and confidentially. Communication and Coordination:
- Communicate with prescribing physicians, sleep specialists, and other healthcare providers to gather necessary information for prior authorization requests.
- Collaborate with insurance companies and other relevant parties to facilitate the prior authorization process.
- Advocate for patients by providing necessary information and documentation to support the medical necessity of sleep therapy services and equipment.
- Educate patients on their insurance coverage, prior authorization requirements, and the importance of compliance with sleep therapy treatments.
- Ensure compliance with regulatory requirements and insurance policies related to prior authorizations for sleep therapy.
- Stay updated on changes in insurance regulations, coverage policies, and prior authorization procedures specific to sleep therapy.
- Identify opportunities for process improvement and contribute to quality assurance initiatives within the department.
- Employee has an individual responsibility for knowledge of and compliance with laws, regulations, and policies.
- Compliance is a condition of employment and is considered an element of job performance
- Maintain HIPAA/patient confidentiality
- Communication: Effective communication involves both listening and expressing oneself clearly. This skill is crucial in personal relationships, professional settings, and everyday interactions.
- Critical Thinking: The ability to analyze situations, evaluate information, and make reasoned decisions is essential for problem-solving and innovation.
- Adaptability: Being adaptable means being flexible and open to change. This skill helps individuals navigate new environments, overcome obstacles, and thrive in diverse situations. •Resilience: Resilience is the capacity to bounce back from setbacks, adversity, or stress. It involves coping with challenges, maintaining a positive outlook, and persevering in the face of obstacles.
- Time Management: Effective time management involves prioritizing tasks, setting goals, and allocating time efficiently. This skill helps individuals maximize productivity and balance competing demands.
- Previous experience in prior authorization, insurance verification, or medical billing, particularly in the sleep medicine or DME field, is advantageous.
- Strong understanding of medical terminology, insurance terminology, and sleep disorders and treatment options.
- Excellent communication skills, both verbal and written, with the ability to interact professionally with patients, healthcare providers, and insurance representatives.
- Attention to detail and accuracy in documentation and data entry.
- Proficiency in using electronic health record (EHR) systems, billing software, and Microsoft Office applications.
- Ability to work independently, prioritize tasks, and manage time effectively in a fast-paced environment.
- Knowledge of HIPAA regulations and commitment to maintaining patient confidentiality.
Competitive Pay, Health Plans with FSA or HSA options, Dental, and Vision Insurance, Optional Life Insurance, 401K with Company Match, 12 weeks of parental leave for birthing parent/ 4 weeks leave for non-birthing parent(s), Additional Parental benefits to include fertility stipends, free diapers, breast pump, Paid Holidays, PTO Accrual from day one, Employee Assistance Programs and SO MUCH MORE
Here at Aeroflow, we are proud of our commitment to all of our employees. Aeroflow Health has been recognized both locally and nationally for the following achievements:
- Family Forward Certified
- Inc. 5000 Best Place to Work award winner
- HME Excellence Award
- Sky High Growth Award
If you've been looking for an opportunity that will allow you to make an impact, and an organization with unlimited growth potential, we want to hear from you
Aeroflow Health is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
