Job Description
Location: New Hyde Park NY
Reports To: DME Manager
Company: CureMedRX
⚠️ IMPORTANT: PLEASE READ BEFORE APPLYING
We are looking for Serious Applicants with Direct Experience only. If you do not have a proven track record in Prior Authorizations (specifically within the DME space), please do not apply. We will only accommodate candidates who demonstrate expertise in this field during the initial screening.
Job Summary
CureMedRX Pharmacy is seeking a meticulous Prior Authorization (PA) Specialist to join our Durable Medical Equipment (DME) team. You will manage the end-to-end PA process, ensuring patients receive timely access to essential medical equipment and services. This role serves as a critical liaison between patients, healthcare providers, and insurance carriers.
Key Responsibilities
Intake & Verification: Gather and audit patient demographics, prescriptions, ICD-10 codes, and clinical documentation for 100% accuracy before submission.
Insurance Navigation & Portals: Execute carrier-specific PA procedures across multiple platforms, including:
Online Submissions: Professional-level navigation of Availity (HealthFirst, Northwell, Aetna, Anthem, and Blue Cross/Blue Shield).
Manual Processing: Handling GHI/Emblem deductible verification and WellCare fax submissions.
Case Management: Tracking authorization status proactively to prevent delays in patient care.
Required Qualifications
Direct DME Experience: Must have a background in Durable Medical Equipment or a closely related pharmacy/insurance role.
Software Proficiency: Expert knowledge of Availity and standard insurance portals.
Coding Knowledge: Strong working knowledge of ICD-10 codes and medical terminology.
Professionalism: Excellent written/verbal communication and a high level of attention to detail.
How to Apply
Please include a brief summary of your specific experience with DME Prior Authorizations and which insurance portals you are most familiar with.
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