HME Authorization Specialist

Since 2012, Giving Home Health Care has been supporting individuals impacted by health conditions related to their work in nuclear facilities for the Department of Energy. With a focus on personalized, in-home care, we are committed to assisting those who have dedicated their careers to these vital roles. As a fast-growing, leading provider, we proudly serve patients across Arizona, Colorado, Kentucky, Missouri, Nevada, New Mexico, Tennessee, Texas, and Utah. If you’re a compassionate individual who puts patients first and thrives in a mission-driven, collaborative environment, we want you to join our team! Apply today and help us continue delivering exceptional care to those who need it most. Job Description The HME Specialist will serve as a critical member of the Giving Home Medical Equipment patient service team, specializing in the Prior Authorization Management. As part of the HME Operations Team which compiles, submits, and manages all Prior Authorization requests to the Dept of Labor. Responsibilities Coordinate with internal Giving Home Medical Equipment, Home Health Care, and external referral sources to collect and verify patient information and medical documentation. Manage Document transfers from software platforms to organize patient documents appropriately. Communicate with internal and external team members when necessary for retrieval of documentation from physician offices. Scanning of mailed responses from Payors into Brightree and Salesforce systems. Verify appropriate coding, cost, frequency and duration of requested Medical Equipment using Brightree. Compile Prior Authorization packets and submit them through Payor Portals. Manage Payor Portal Authorization updates and communicate these updates to team members. Update Patient Records appropriately based on Authorization responses. Update Salesforce and Brightree appropriately based on Authorization responses to direct actions to team members. Monitor Authorization steps taken to ensure timeliness and compliance. Complete tasks and Authorization requests promptly and within allowable timelines. Place calls to DOL Medical Benefits Examiners to determine the reasoning behind Authorization processing decisions. Receive calls from DOL Medical Benefits Examiners regarding questions for submitted Authorization Requests. Communicate effectively and professionally with Payor representatives to ensure appropriate processing of Authorization Requests. Collaboration with HME Operations and Billing Departments. Assist HME Operations with the monitoring and working of reports to facilitate Prior Authorization needs. Collaborate with Billing Departments for Pricing/Fee Schedule Updates. Collaborate with HME and Home Health departments as necessary. Communicate with patients/care team members/DOL via inbound and outbound phone calls. Act as a liaison between patients, Home Health teams, clinicians, and payers to ensure seamless communication and service delivery. Perform Other Duties as Necessary. Assist Giving HME as a whole by performing additional duties and responsibilities as necessary to provide the best care possible for patients. Qualifications High school diploma or GED required; Associate’s or Bachelor’s degree in a healthcare-related field preferred. Minimum 3 years of experience in a DME business environment perferred. Familiarity with DOL, DEEOIC, and private insurance billing processes is a plus. Deep and instinctual understanding of Durable Medical Equipment and Home Medical Equipment. Its use, functions, and care. Excellent communication and customer service skills. Strong and kind phone presence. Detail-oriented with strong organizational abilities. Brightree Experience. Salesforce experience. Strong time management skills. Office-based, on-site role. May require standing, sitting, or lifting equipment up to 50 pounds. Must be able to work collaboratively in a fast-paced, compliance-focused healthcare environment. Background check, fingerprinting and TB test required. To provide the exceptional care our patients deserve, we rely on a team of passionate, dedicated professionals. We’re committed to creating a supportive, collaborative culture, offering competitive benefits and compensation, and giving our team members the tools and opportunities to grow and advance their careers. If you’re ready to be part of an organization that truly makes a difference in people’s lives, we encourage you to apply today and start a fulfilling journey with Giving Home! Giving Home is dedicated to fostering an inclusive and equitable work environment. We adhere to all applicable federal, state, and local pay transparency laws to ensure fair compensation practices. Giving Home is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other protected characteristic under applicable law. Our employment practices are designed to provide equal opportunity at all stages of employment, including hiring, promotion, training, compensation, and termination. Giving Home is committed to maintaining transparent compensation practices and regularly reviews our policies to ensure compliance with evolving laws and best practices. We value the contributions of our employees and strive to provide a work environment where everyone feels respected, valued, and fairly compensated. #J-18808-Ljbffr Givinghhc