ABC Medical

Work Location:

Spokane, WA - onsite Monday-Friday; Hours: 8:30am-5pm PST

Responsibilities:

The Referral Specialist is responsible for verifying, obtaining, reviewing, and accurately determining that all medical documentation received from physicians or referral sources meet all local coverage determinations and regulatory requirements. The Referral Specialist is responsible for the Pre-authorization functionality.

• Examine documents to verify required compliance, completeness, and accuracy of data.
• Confer with document originator and approvers to resolve identified discrepancies.
• Contact insurance companies to confirm insurance coverage and eligibility of products.
• Obtain prior authorization and/or referrals.
• Appropriately update customer database when obtaining documents and pre-authorizations.
• Appropriately update document databases, and corresponding files.
• Generate communication to the appropriate personal on new and revised documents including Pre-authorization request.
• Regularly communicate with Health Care Providers, Commercial and Government Payors, and Sales Managers.
• Achieve defined service level agreements.
• Communicate Payor requirements as they are discovered.
• Adheres to all HIPAA guidelines/regulations.

Minimum Qualifications:

• High School Diploma or equivalent work experience
• 2+ years of work experience
• Basic understanding of payor guidelines
• Analytical skills required, attention to detail, and organized
• Basic Microsoft skills.
• Ability to work well in a team environment

Preferred Qualifications:

• Previous DME experience

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

The anticipated base salary range for this position is $18.00-$22.00. The actual salary varies based on applicant's location, education, experience, skills, abilities, and other legitimate business factors. The Company also provides a unique Benefit of Employee Share Ownership Program (BESOP) program.

• The Company's health and welfare benefits include: medical, prescription, dental, vision, spending/savings accounts, disability, statutory leaves/disability programs, accident, life, wellbeing, and voluntary benefit programs.
• The Company's 401(k) Retirement Savings Plan includes: vesting and eligible participants "safe harbor" matching contributions.
• The Company's paid time off benefits include: 8 paid holidays and paid vacation based on length of service and exempt/non-exempt status.

To make life more rewarding and dignified for the people who use our products and services.