ABC Home Medical Supply, Inc is oneof the nation's leading urological supply providers andserves as a one-stopshop with a comprehensive line of medical supplies and service that includes: Urological, Incontinence, Wound Care, and Ostomy. ABC Medical is part of the JDS, Inc family of businesses. Our service companies possess the knowledge and expertise to deliver first-class products and personalized home healthcare services.

Location: Port Saint Lucie
Department: Operations

Work Location:

Port Saint Lucie, FL - onsite Monday and Tuesday; hours are 8:30am-5pm EST

Responsibilities:

The Referral Specialist is responsible for verifying, obtaining, reviewing, and accurately determining that all medical documentation received from physicians or referral sources meets all Local Coverage Determinations and regulatory requirements. The Referral Specialist is responsible for the pre-authorization functionality.

• Perform insurance eligibility verification utilizing various methods including portals and phone calls to confirm insurance coverage and eligibility of products. Obtain required documentation with regular communication via phone and fax to offices.
• Examine received documents to verify required compliance, completeness, and accuracy of data.
• Confer with Physician/Provider offices and approvers to resolve identified discrepancies and ensure that the needed documents support the services we are providing.
• Request/Submit and follow up for Prior Authorizations (PARs) and PCP referrals.
• Generate communication to the appropriate personal on new and revised documents including Prescriptions and Pre-authorization request.
• Regularly communicate with Territory Manager's Physician/Providers, Payors, and internal departments.
• Update customer database with detailed plan information when obtaining insurance policy information.
• Appropriately update customer database when obtaining Prescriptions, office notes, pre-authorizations, and other documents.
• Notate all customer accounts with all actions taken in clear and detailed language.
• Communicate Payor requirements as they are discovered.
• Achieve defined SLA's.
• Quickly assess situations and respond appropriately; handle special requests in a sensitive, professional manner.

Minimum Qualifications:

• High School Diploma or equivalent work experience
• Basic understanding of payor guidelines which includes reading, understanding and interpreting medical records, payor requirements etc
• 2+ years of work experience in insurance verification/referrals
• Working knowledge of Microsoft Office suite, including working within Excel tabs and analyzing information
• Strong multitasking, attention to detail, organizational and communication skills (written and verbally)
• Working knowledge of all HIPAA guidelines/regulations and adherence to them
• Ability to work well in a team environment

Preferred Qualifications:

• Previous DME experience a plus

Here's what we have to offer:

• Variety of Medical, Dental and Vision Insurance Plans
• 401k Plan with Company Match
• PTO and Paid Holidays
• EAP
• Employee Discounts

Job Req ID: 32990