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 doc...