Continued Qualification Specialist

Description: primary responsibility is to obtain all necessary documentation required by the patient’s insurance provider to continue qualified and authorized use of DME products. This position plays a critical role in ensuring the seamless coordination of continued or transitioned therapy, facilitating efficient billing processes, and minimizing financial burdens for the payer, the patient and the product provider.

• Understanding of DME products and their application and benefit to patient healing in the home.

• Routine/scheduled contact with patients to verify active and compliant use of therapy products, active insurance coverage, and active healthcare providers.

• Maintain accurate and real-time records of clinical visits, patient assessments, patient demographics, insurance information, authorizations, coverage details and communication trail in digital platforms or designated database.

• Assess patients' eligibility for specific therapy determined by insurance clinical/compliance guidelines and coverage or contract limitations.

• Perform necessary and timely reauthorization of patients' insurance coverage for continued therapy in the home, including reviewing clinical/compliance eligibility criteria, insurance plans, and benefits.

• Collaborate with the billing department to ensure accurate and timely claim submissions, including the completion of necessary documentation and adherence to insurance company requirements.

Skills:

customer service, benefits administration, data entry, Prior authorization, healthcare customer service, Healthcare Administration

Additional Skills & Qualifications:

• Proven experience in insurance verification within a medical or healthcare setting.

• Comprehensive knowledge of various insurance plans, including private insurance, Medicare, Medicaid, and managed care organizations.

• Familiarity with medical terminology, CPT codes, and ICD-10 coding system.

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.