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Reimbursement Authorization Specialist

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Posted: 01/09/2022

Location: Ayer, MA Department: Reimbursement

Job Summary:

The role of the Reimbursement Authorization Specialist (RAS) 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 in located in Ayer, MA with flexibility for limited remote work. The core hours of operation are 8:30 am to 5:30 pm.

Essential Duties:
  • Ensure Ajinomoto Cambrooke, Inc. (ACI) has 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).
  • Continue to work and maintain such documents so effective dates are always current.
  • Provide guidance for patient(s) and their families working through eligibility and prior authorization process with payers.
  • 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.
  • Interact with Client Services and the A/R Collection team members to resolve or avoid claim issues.
  • Communicate and work collaboratively with registered dietitians and regional sales team.
  • Maintain medical records in compliance with HIPAA rules and regulations.
  • Working knowledge of A/R and Collection to understand outstanding previous unpaid or rejected claims.
  • Adhering to all company SOPs with regards quality and safety.
  • Other duties as assigned.
Education and/or 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.
  • Working knowledge of commercial and state payers claim processing and procedures (including Medicare, Medicaid, and WIC).
  • Medical Terminology and/or Clinical Nutrition knowledge a plus.
  • Proficiency in Microsoft Office; Excel, Word, Teams, etc.
  • Previous experience with SalesForce or Nexternal preferred but not required.
  • Strong written and oral communications skills required.
  • Demonstrated sense of 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.
  • Knowledge of HIPAA and the ability to maintain confidential information security relative to all company’s proprietary information.
  • Must be results and people-orientated having the ability to balance business and relationship considerations.
  • Detailed oriented with a strong mathematical aptitude.
  • Must maintain information security with regard to all company’s proprietary information.
Minimum Qualification Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Ability to multi-task and work well under pressure.
  • Ability to focus on details to ensure accurate data entry.
  • Ability to communicate effectively through written and oral communications.
  • Ability to be reliable, dependable, punctual, and demonstrate a strong work ethic.
  • Ability to interact well with all levels of the organization and in alignment with company’s overall goals.
  • Ability to occasionally lift 10 lbs., reach, bend, stoop.
  • Ability to work in a seated position for up to 8 hours a day.
  • Ability to utilize a telephone, headset, and computer.
  • Ability to perform multi-faceted projects in conjunction with day-to-day activities.
  • Ability to think analytically and to assist with new initiatives and process improvements to enhance Company mission and values.
  • Ability to successfully function and accurately manage workflow during high volume, critical situations.
  • Ability to identify potential risks and take proactive steps to prepare for critical situations.

Ajinomoto Cambrooke, Inc. is an Equal Opportunity Employer-Vets/Disabled, committed to a diverse workforce. If you need assistance with completion of an application for employment, please contact Human Resources Department at 978-862-1980.

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