WHO WE ARE

PromptCare is a leading provider of home respiratory and infusion services, serving pediatric and adult patients in 18 states from 29 locations throughout the Eastern and Mid-Western United States. Our Hi-Tech, Hi-Touch care offerings deliver superior patient care and outcomes making PromptCare a preferred partner for hospitals, physicians, and payors. PromptCare currently services 2,800 ventilation patients, 850 infusion patients, and 3,400 enteral nutrition patients. We estimate that we are the largest provider of ventilation care to pediatric patients in the U.S. Our mission is to be the preferred choice for superior management of complex cases, providing unsurpassed clinical expertise, reliable service, and boundless compassion in transitioning patients to the home setting and reuniting them with their loved ones. Our Differentiation consists of an unrivaled team of respiratory therapists, nurses, dietitians, pharmacists, and other care professionals who provide highly sought-after expertise, advice, and patient care. We are the “go-to” provider in our markets among leading pediatric hospitals and care facilities to handle the most acute patient situations. PromptCare holds an expansive payer network participation, supported by a robust billing & collections operation.

PromptCare is looking for a Reauthorization Specialist to join our Intake Department. This is a full-time position, 40hrs per week. Mon-Fri

Job Summary

The position will entail the timely submission of authorization requests to assigned payers. Submission of requests will be completed using paper forms, printed documentation, fax, payer portals or other means. Complete follow up on requests to ensure timely turnaround and approval. Understand payer requirements to ensure approval is granted. Escalate problem accounts and ensure resolution. Regular contact with patients, insurance plans, physician offices, respiratory therapists and other personnel is necessary.

• High School Diploma or equivalent.
• Experience in medical office, patient contact and related experience.
• Microsoft Office Suite experience.
• Excellent oral and written communication skills are required to communicate with colleagues, management, patients, and physician offices.
• Medical Reimbursement background is preferred.

Job Responsibilities, included but not limited to:

• Initiate new and concurrent authorization requests to insurance payers for Home Infusion Therapy.
• Completes follow-up on pending and or expired authorizations.
• Review authorization approvals and denials for accuracy and initiate appeal process until the case is overturned, appeal options are exhausted, or a decision is made to discontinue the process.
• Documents details of all calls, faxed, and email communications in CPR+ per SOP of the department.
• Maintains documented record of approved/denied authorizations in the patients’ chart for reference.
• Maintains strict confidentiality and adhere to HIPPA guidelines and regulations.
• Maintains a broad range of knowledge of insurance plan requirements, medical terminology, government regulation, and codes.
• Timely follow-up and response for all quality reviews.
• Work as a team player and shares knowledge gained per insurance updates ad communications with management and team members.
• Other duties as assigned by Intake Manager.

Physical Demands

Lifting, Carrying, Pushing and Pulling

Benefits & Perks

• Competitive Salary
• Medical, Dental, Vision Package
• 401(k) plan (discretionary)
• PTO - Vacation, Sick and Personal days, and paid holidays
• Referral bonuses & Plum Benefits Discount Ticket Program
• Lunch & Learn Programs
• Employee Recognition Program

Equal Employment Opportunity

The PromptCare Companies is committed to Equal Employment Opportunity (EEO) and prohibits employment discrimination on the basis of race, color, age, national origin, religion, gender, gender identity, sexual orientation, pregnancy, marital status, genetic disposition, disability, veteran's status or any other characteristic or classification protected by State/Federal/Local laws. We foster a work environment in which diversity and inclusion are embraced, people are hired and advanced on their merits, and employees are treated with mutual respect and dignity.