Pre-Registration, VOB & Pre-Authorization Specialist (DME, Lab, & PT Expertise)

Role Description

Pre-Registration, Verification of Benefits (VOB), and Pre-Authorization Specialist

Key Responsibilities

• Verification of Benefits (VOB) & Eligibility:

   
• Conduct thorough and accurate VOB for all incoming DME, Lab, and PT services, contacting commercial, federal (Medicare/Medicaid), and state payers. 
• Identify patient financial responsibility (co-pays, deductibles, co-insurance) and communicate this information clearly and professionally to the patient or client. 
• Expertise in interpreting complex DME benefits, Lab service carve-outs, and specific visit limits/authorization requirements for Physical Therapy. 

• Pre-Authorization/Prior Authorization Management:

   
• Manage the entire prior authorization lifecycle for complex DME items, high-cost Lab tests, and extended or ongoing PT treatment plans. 
• Prepare, submit, and track authorization requests electronically and telephonically, ensuring all required clinical documentation is included to meet payer-specific criteria. 
• Proactively follow up on pending authorizations and appeal denials as necessary to prevent service delays or claim rejections. 

• Pre-Registration & Patient Intake:

   
• Complete accurate and timely patient pre-registration, verifying demographic and insurance information in the Practice Management System. 
• Coordinate closely with clients and clinical staff to ensure all necessary intake forms and consent documents are obtained prior to service delivery. 

• Technical and Administrative Proficiency:

   
• Utilize and maintain proficiency with Practice Management Systems (

  PMS

  ) such as

  NextGen, Tebra, and Brightree

  for patient intake, VOB, and authorization tracking. 
• Prepare detailed VOB/Authorization reports and tracking documents using

  Microsoft Excel, Word, and PowerPoint

  . 

• Stakeholder Interaction & Collaboration:

   
• Maintain professional and empathetic communication (

  client handling

  ) with patients, providers, and clients regarding benefits, authorizations, and financial responsibilities. 
• Actively participate in

  cross-departmental collaboration

  with credentialing, billing, and clinical teams to ensure a seamless handoff of patient information and authorization data.