HME Authorization & Reimbursement Coordinator

Insurance verification and prior authorization

• Verify patient eligibility, benefits, coverage limitations, deductibles, co-pays, and payer-specific requirements for HME equipment and services.
• Manage ongoing prior authorizations and re-authorizations for existing patients.
• Submit accurate authorization requests through payer portals, fax, and electronic systems.
• Monitor authorization expiration dates, coverage periods, and payer-specific requirements.
• Review clinical and supporting documentation to ensure medical necessity and compliance.
• Communicate approvals, denials, changes, and outstanding requirements to internal teams.
• Research authorization and coverage issues and assist with denial management and appeals.

Billing and reimbursement

• Prepare and submit HME claims to Medicare, Medicaid, commercial insurance, and other payers.
• Verify patient demographics, insurance information, equipment details, authorizations, and supporting documentation before billing.
• Post payments, adjustments, denials, and other billing transactions accurately.
• Research and resolve billing, insurance, eligibility, and coverage issues.
• Communicate with insurance companies and patients regarding billing and payment issues.
• Gather supporting documentation for denied claims and assist with appeals follow-up.
• Maintain accurate billing and insurance records in accordance with payer requirements, HIPAA, and organizational policies.
• Maintain knowledge of HME billing requirements and Medicare/Medicaid guidelines.

Medical records and quality coordination

• Process incoming medical records, physician orders, faxes, and other clinical documentation.
• Track documentation requiring physician signatures or additional information.
• Monitor outstanding orders, CMNs, clinical documentation, and other medical record requirements.
• Use physician portals and other systems to obtain supporting documentation.
• Maintain physician and referral source information.
• Assist with medical record reviews and chart audits.
• Compile documentation for medical record requests and internal or external reviews.
• Collaborate with billing, intake, clinical, and quality improvement teams to resolve documentation deficiencies.

Communication and customer support

• Serve as a point of contact for patients, referral sources, physicians, insurance representatives, and internal teams.
• Respond to incoming calls and inquiries regarding insurance, authorization, billing, and documentation.
• Provide backup support for HME intake and order processing, including referrals, patient and order entry, documentation review, and follow-up.
• Assist with coordinating equipment orders and communicating with customer service, warehouse, delivery, and clinical teams.
• Provide intake on-call support as needed, including participation in an on-call rotation.
• Escalate unresolved or time-sensitive issues appropriately.

Equal Employment Opportunity Employer.

The employer states a commitment to a work environment free of discrimination, harassment, and workplace violence, with zero tolerance for discrimination or harassment and a culture of inclusion and respect.