A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
32 hours per week to start, with the expectation of transitioning to 40 hours per week based on performance and business needs
Reports To:
Care Team Lead and General Manager Position Summary Forester Family Medical Supply is seeking an organized and detail-oriented Prior Authorization Representative to coordinate authorization requests for durable medical equipment and medical supplies. This position is responsible for reviewing patient documentation, submitting prior authorization requests, monitoring authorization statuses, and creating delivery tickets once authorizations are approved. The Prior Authorization Representative will communicate regularly with patients, caregivers, medical providers, insurance companies, and internal departments to help ensure patients receive their medically necessary equipment and supplies without unnecessary delays. Primary Responsibilities Review patient orders and supporting documentation for completeness and accuracy. Confirm that prescriptions, chart notes, letters of medical necessity, and other required documents meet insurance guidelines. Verify patient demographics, insurance eligibility, benefits, and prior authorization requirements. Prepare and submit prior authorization requests through insurance portals, fax, email, or other required submission methods. Monitor submitted requests and follow up on pending authorizations. Respond promptly to requests for additional information from insurance companies or authorization review organizations. Communicate with medical providers to obtain missing, updated, or corrected documentation. Track authorization effective dates, expiration dates, approved quantities, and covered equipment or supplies. Review approval notices to confirm that the authorized products, billing codes, units, service dates, and other details are correct. Create accurate delivery tickets for approved authorizations, ensuring the correct patient information, products, quantities, billing codes, authorization details, and delivery instructions are included. Send completed delivery tickets to the appropriate department for purchasing, preparation, scheduling, and delivery. Communicate authorization decisions and status updates to patients, caregivers, and internal departments. Review denial notices and identify the reason for each denial. Assist with reconsiderations, resubmissions, and appeals when appropriate. Maintain detailed and accurate notes regarding calls, faxes, submissions, approvals, denials, and authorization updates. Coordinate with the intake, documentation, renewal, billing, purchasing, and logistics departments. Escalate complex cases, repeated delays, and coverage concerns to the appropriate supervisor. Follow all company procedures, payer requirements, and HIPAA regulations. Assist with phone coverage and additional administrative responsibilities as needed. Meet departmental expectations for productivity, accuracy, communication, and timely follow-up. Perform other duties as assigned based on company needs. Qualifications High school diploma or equivalent required. Previous experience with healthcare authorizations, insurance verification, medical billing, durable medical equipment, or medical administration is preferred. Knowledge of Medicaid, Medicare, and commercial insurance requirements is preferred. Strong attention to detail and accuracy. Excellent organization, time-management, and follow-up skills. Strong written and verbal communication skills. Ability to review medical documentation and follow detailed insurance guidelines. Comfortable communicating with patients, caregivers, medical provider offices, and insurance representatives. Ability to manage multiple cases, deadlines, and priorities. Basic computer skills and the ability to learn insurance portals and company systems. Ability to work independently while also contributing to a team environment. Dependable attendance and consistent punctuality are required. Bilingual English and Spanish is a plus. Schedule and Growth This position will begin at approximately 32 hours per week , with the expectation of transitioning to a 40-hour, full-time schedule . The timing of this transition will be based on training progress, job performance, workload, and company needs. What We're Looking For The successful candidate will demonstrate: Strong attention to detail Consistent and timely follow-through A patient-first approach A strong sense of urgency Professional and positive communication Accountability and dependability The ability to problem-solve and research payer requirements A willingness to learn and grow with the company Forester Family Medical Supply is a growing, family-owned durable medical equipment provider serving pediatric and adult patients throughout Colorado. Our team works together to help patients receive the medically necessary supplies and equipment they need through compassionate, responsive, and dependable service.
