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. This is an onsite position with openings at either Springfield VA, Little Rock AR, or Trevose PA.

• 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.

• 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

• Previous DME experience

• Variety of Medical, Dental and Vision Insurance Plans
• 401k Plan with Company Match
• PTO and Paid Holidays
• EAP
• Employee Discounts