job description
Join Adec Innovations as a Clinical Prior Authorization Specialist (DME/Ventilator) and play a pivotal role in ensuring seamless healthcare delivery. In this position, you will review and validate Durable Medical Equipment (DME) and ventilator orders to ensure compliance with Medicare regulations, preventing claim denials and expediting reimbursement processes. Your expertise will directly impact patient care by ensuring timely and accurate equipment dispensing.
Based in the serene and vibrant island of Bali, this role offers a unique opportunity to blend professional growth with an exceptional quality of life. If you are detail-oriented, passionate about healthcare compliance, and eager to contribute to a dynamic team, we invite you to apply.
Responsibility
- Review and verify DME and ventilator orders for accuracy and compliance with Medicare and other regulatory guidelines.
- Collaborate with healthcare providers, suppliers, and insurance companies to resolve discrepancies and obtain necessary authorizations.
- Ensure all documentation is complete and accurate to prevent claim denials and delays in reimbursement.
- Maintain up-to-date knowledge of Medicare policies, coding requirements, and industry best practices.
- Communicate effectively with internal teams and external stakeholders to facilitate smooth order processing.
- Document and track authorization requests, approvals, and denials for reporting and auditing purposes.
- Identify trends in claim denials and recommend process improvements to enhance efficiency.
- Provide training and support to team members on prior authorization processes and compliance standards.
Qualifications
- Bachelor's degree in Nursing, Healthcare Administration, or a related field.
- Minimum of 2 years of experience in prior authorization, medical billing, or a similar role within the healthcare industry.
- Strong understanding of Medicare guidelines, DME coding, and medical terminology.
- Excellent analytical and problem-solving skills with a keen attention to detail.
- Proficient in using healthcare management software and Microsoft Office Suite.
- Outstanding communication and interpersonal skills to interact with healthcare professionals and insurance representatives.
- Ability to work independently and manage multiple tasks in a fast-paced environment.
- Certification in medical coding (e.g., CPC, CCS) is a plus.