Reimbursement Authorization Specialist I

The role of the Reimbursement Authorization Specialist I is integral to the success of the Revenue Cycle Team. In this role, you will be a patient-focused liaison to assist customers (patients) with access to Cambrooke medical foods and formulas through the referral process. This position requires the ability to interact professionally with patients, insurance companies, institutions (including state programs, clinics, and other health professionals), as well as internal employees. This position is located in Ayer, MA with flexibility for limited remote work. The core hours of operation are 8:30 am to 5:00 pm. Ensure Ajinomoto Cambrooke, Inc. (ACI) has the necessary documentation to start the referral process. Contact healthcare professionals, state agencies, and payers (insurance companies) for clinical documents, eligibility, benefits, prior authorization, single case agreements, letter of agreements and any other items to ensure payment on an as needed basis (e.g., when authorization expires). Assists in uploading current documents and populating required fields in Sales Force. Continue to work and maintain such documents so effective dates are always current. Ensures all incoming requests are worked and responded to timely, following the guidelines set forth within Revenue Cycle Department. Coordinate with other contracted Durable Medical Equipment companies and/or Pharmacies to ensure that patient(s) and their families can obtain the formula and medical foods they require. Provides assistance and guidance for patient(s) and their families working through eligibility, benefit verification and prior authorization process with payers. Provides excellent customer service resolving inquiries & issues in a timely, professional, and caring manner with compassion and drive to ensure patient(s) and their families receive optimal coverage so they can receive Cambrooke products with the least financial impact on them. Prioritizes all Pre-Orders waiting for most recent SF Case to be finalized and all documents signed and approved. Communicate and work collaboratively with registered dietitians and regional sales team. Converse with Medical Billing and Collection Team to gain knowledge and understand open, unpaid or rejected claim(s) for previous orders. Maintain medical records in compliance with HIPAA rules and regulations. Adhering to all company SOPs with regards quality and safety. Other duties as assigned.

EDUCATION, CERTIFICATIONS AND EXPERIENCE

Minimum High School Diploma or equivalent; College degree a plus. 2 plus years work experience in medical billing, eligibility, authorization, and interaction with payers. Understanding of HCPCs and ICD10 coding. Knowledge of third-party rules and regulations to include contracts and agreements.

KNOWLEDGE, SKILLS AND ABILITIES

Proficiency in Microsoft Office; Excel, Word, Teams, etc. Previous experience with SalesForce or an Order Management System (OMS) preferred but not required. Ability to multi-task, with attention to detail to ensure accuracy. Able to prioritize work, anticipate department needs, plan accordingly and able to handle the many interruptions with ease. Strong written and oral communications skills required to provide excellent customer service and/or Revenue Cycle updates. Demonstrated sense of compassion and drive to ensure patient(s) and their families receive optimal coverage so they can receive Cambrooke products. Ability to work independently with minimal direction, take initiative within scope of work responsibilities Must be a strong team player working with the various Revenue Cycle Teams and be able to initiate activity and/or promptly communicate & mentor others. Must have great listening skills to work with team members, other colleagues, and outside customers & clinics, to identify and initiate suggestions, guidance and/or resolution. Must be results and people-orientated having the ability to balance business and relationship considerations. Knowledge of HIPAA and the ability to maintain confidential information security relative to all company's proprietary information. Must maintain information security with regard to all company's proprietary information.