HME Authorization & Reimbursement Coordinator

The HME Authorization & Reimbursement Coordinator is responsible for managing ongoing prior authorizations, insurance verification, billing and reimbursement, and medical record documentation for Suburban Home Medical Equipment (HME). This role ensures authorization and coverage requirements are met, claims are processed accurately and timely, and required documentation is maintained in compliance with payer and regulatory guidelines. The position collaborates with insurance carriers, patients, referral sources, and internal teams to support continuity of equipment services, timely reimbursement, and regulatory compliance while providing backup support for HME intake and order processing as needed. Insurance Verification & 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 to support continued equipment use and prevent interruptions in coverage. Submit accurate and complete authorization requests through payer portals, fax, and electronic systems within required timeframes. Monitor authorization expiration dates, coverage periods, and payer-specific requirements; proactively initiate renewals and follow up on pending requests. Review clinical and supporting documentation to ensure medical necessity and compliance with payer requirements for initial and ongoing authorizations. Communicate authorization approvals, denials, changes, and outstanding requirements to appropriate internal teams. Research authorization and coverage issues, escalate delays as needed, and assist with denial management by gathering documentation and supporting appeals. Maintain accurate authorization information and supporting records in HME and billing systems. Billing & Reimbursement Prepare and submit accurate HME claims to Medicare, Medicaid, commercial insurance, and other applicable payers. Verify patient demographics, insurance information, equipment details, authorizations, and supporting documentation for accuracy and completeness prior to billing. Post payments, adjustments, denials, and other billing transactions accurately in the billing system. Research and resolve billing, insurance, eligibility, and coverage issues in coordination with payers, patients, and internal staff. Communicate with insurance companies and patients regarding billing inquiries, coverage requirements, and payment issues. Gather supporting documentation for denied claims and assist with appeals and reimbursement-related follow-up. Maintain accurate and organized billing and insurance records in accordance with payer requirements, HIPAA, and organizational policies. Maintain knowledge of HME billing requirements, Medicare and Medicaid guidelines, and applicable payer policies. Medical Records & Quality Coordination Process incoming medical records, physician orders, faxes, and other clinical documentation, ensuring records are attached to the appropriate patient account or chart in a timely manner. Send, track, and follow up on documentation requiring physician signatures or additional information. Monitor outstanding orders, Certificates of Medical Necessity (CMNs), clinical documentation, and other medical record requirements to support compliance with payer guidelines and organizational policies. Utilize physician portals and other systems to obtain medical records and supporting documentation as needed. Maintain accurate physician and referral source information and related documentation. Assist with medical record reviews and chart audits to identify documentation gaps and support regulatory compliance and quality improvement initiatives. Compile documentation for medical record requests and internal or external reviews. Collaborate with billing, intake, clinical, and quality improvement teams to resolve documentation deficiencies. Maintain records in accordance with HIPAA, CMS requirements, payer guidelines, and organizational policies and procedures. Communication & Customer Support Serve as a point of contact for patients, referral sources, physicians, insurance representatives, and internal teams regarding HME authorizations, insurance coverage, billing, and documentation. Respond to incoming calls and inquiries, providing timely and professional assistance with insurance, authorization, and billing questions. Provide backup support for HME intake and order processing as needed, including receiving and reviewing referrals, entering patient and order information, verifying required documentation, and following up on missing information. Assist with coordinating equipment orders and communicating with customer service, warehouse, delivery, and clinical teams to support timely equipment processing and delivery when providing intake coverage. Coordinate with internal departments to ensure authorization, documentation, billing, and reimbursement processes proceed efficiently. Escalate unresolved or time-sensitive issues appropriately to help prevent delays in patient services or reimbursement.