Healthcare Admin Specialist

As a Patient Administration Specialist with Ethos, you will review, organize, and manage the process for new product placement for durable medical equipment in the home environment. Our Healthcare Administrators work with internal and external teams to ensure timely product deliveries and patient/contract compliance. Administrators engage with patients, caregivers, referral sources and payers daily.

If you have experience in Healthcare Administration or a related degree, this is a great opportunity to make a difference with a growing company! These positions work traditional hours M-F with Holidays off, PTO, Sick, Medical Benefits & more! These positions are located in Blue Bell, PA and working in the Blue Bell office is required.

Responsibilities:

• Products: Acquire a deep understanding of Ethos products and their application and benefit to patient healing in the home.
• Communication: A) Routine/scheduled contact with patients to verify active and compliant use of therapy products, active insurance coverage, and active healthcare providers. B) Routine/scheduled contact with health care providers to obtain payer required documentation to maintain therapy in the home. C) Routine/scheduled contact with in-house stakeholders to coordinate necessary and timely product transitions based on patients' eligibility for specific therapy determined by insurance guidelines and coverage limitations.
• Documentation: Maintain accurate and real-time records of clinical visits, patient assessments, patient demographics, insurance information, authorizations, coverage details and communication trail in digital platforms or designated database.
• Eligibility Assessment: Assess patients' eligibility for specific therapy determined by insurance clinical/compliance guidelines and coverage or contract limitations.
• Insurance Reauthorization: Perform necessary and timely reauthorization of patients' insurance coverage for continued therapy in the home, including reviewing clinical/compliance eligibility criteria, insurance plans, and benefits.
• Escalation: Timely escalate cases that have or could result in delayed claims submission or unbilled claims such as product transitions, non-compliance, denied appeals.
• Claim Processing: Collaborate with the billing department to ensure accurate and timely claim submissions, including the completion of necessary documentation and adherence to insurance company requirements.
• Problem Resolution: Investigate and resolve insurance-related issues, such as denied reauthorization claims and delays by working closely with insurance companies, patients, healthcare providers and in-house stakeholders.
• Compliance: Adhere to federal and state regulations, as well as insurance policies and guidelines, to maintain accurate and ethical practices in insurance reauthorization processes.
• Continuous Improvement: Identify opportunities for process improvements and collaborate with the team to enhance efficiency and effectiveness in continued qualification procedures.