DME Specialist AmeriHealth Caritas 342 reviews - Philadelphia, PA Your career starts now. Were looking for the next generation of health care leaders. At AmeriHealth Caritas, were passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, wed like to hear from you. Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com. Responsibilities: Under the general supervision of the Supervisor, responsible for intake of requests for Durable Medical Equipment and outpatient therapy authorizations, including telephone support, data entry, submission to the Health plans Medical Director for medical necessity review, completion of service authorization detail lines, and member/provider notification process. * Responsible for precertification and recertification process for Durable Medical Equipment and selected outpatient therapies. * Follows departmental workflow for prior authorization of request, including documenting receipt of request, member eligibility, submitted information in the internal systems. * Authorizes services based on Plan Guidelines. If unable to approve, submits the request to the Plans Medical Director for medical necessity determination. * Completes detail lines in internal systems to reflect authorization or denial of services. * Follows denial process to provide initial verbal/facsimile notification to provider(s) and generates appropriate written notification to provider(s) and member. Education/Experience: * High School diploma or GED required. * Minimum 2 years of experience in a healthcare related field such as Home Health agency, medical equipment company or managed care experience. * Proficiency with Microsoft Office Suite (Word, Excel, Power Point). Access is a plus. * Experience with ICD-9 and ICD-10. 1 day ago - save job - original job Apply On Company Site Other jobs you may like Enteprise Accreditation Specialist AmeriHealth Caritas Philadelphia, PA 30+ days ago Payment Posting Specialist TalentFleX Solutions Dresher, PA 30+ days ago Easily apply Preregistration Specialist University of Pennsylvania Health System Philadelphia, PA 30+ days ago Cardiac Specialist BioTelemetry, Inc. Ewing, NJ 30+ days ago Cardiac Specialist LifeWatch Services, Inc. Ewing, NJ 30+ days ago * Dme Specialist jobs in Philadelphia, PA * Jobs at AmeriHealth Caritas in Philadelphia, PA * Dme Specialist salaries in Philadelphia, PA AmeriHealth Caritas AmeriHealth Caritas 342 reviews AmeriHealth Caritas is the nation's leader in health care solutions for the underserved and chronically ill, impacting the lives of more... Let employers find you Thousands of employers search for candidates on Indeed Upload Your Resume