Reimbursement Authorization Specialist I

Ajinomoto Health & Nutrition North America, Inc.

Reimbursement Authorization Specialist I assisting patients with Cambrooke medical foods access. Coordinate with healthcare professionals and insurance for eligibility and prior authorization processes.

Posted 6/25/2026full-timeAyer • Massachusetts • 🇺🇸 United StatesJuniorMid-Level💰 $26 - $30 per hourWebsite

About the role

Key responsibilities & impact

Ensure Ajinomoto Cambrooke, Inc. (ACI) has the necessary documentation to start the referral process.
Contact healthcare professionals, state agencies, and payers (insurance companies) for clinical documents, eligibility, benefits, prior authorization, single case agreements, letter of agreements and any other items to ensure payment on an as needed basis (e.g., when authorization expires).
Assists in uploading current documents and populating required fields in Sales Force.
Continue to work and maintain such documents so effective dates are always current.
Ensures all incoming requests are worked and responded to timely, following the guidelines set forth within Revenue Cycle Department.
Coordinate with other contracted Durable Medical Equipment companies and/or Pharmacies to ensure that patient(s) and their families can obtain the formula and medical foods they require.
Provides assistance and guidance for patient(s) and their families working through eligibility, benefit verification and prior authorization process with payers.
Provides excellent customer service resolving inquiries & issues in a timely, professional, and caring manner with compassion and drive to ensure patient(s) and their families receive optimal coverage so they can receive Cambrooke products with the least financial impact on them.
Prioritizes all Pre-Orders waiting for most recent SF Case to be finalized and all documents signed and approved.
Communicate and work collaboratively with registered dietitians and regional sales team.
Converse with Medical Billing and Collection Team to gain knowledge and understand open, unpaid or rejected claim(s) for previous orders.
Maintain medical records in compliance with HIPAA rules and regulations.
Adhering to all company SOPs with regards quality and safety.
Other duties as assigned.

Requirements

What you’ll need

Minimum High School Diploma or equivalent; College degree a plus.
2 plus years work experience in medical billing, eligibility, authorization, and interaction with payers.
Understanding of HCPCs and ICD10 coding.
Knowledge of third-party rules and regulations to include contracts and agreements.
Proficiency in Microsoft Office; Excel, Word, Teams, etc.
Previous experience with SalesForce or an Order Management System (OMS) preferred but not required.
Ability to multi-task, with attention to detail to ensure accuracy.
Able to prioritize work, anticipate department needs, plan accordingly and able to handle the many interruptions with ease.
Strong written and oral communications skills required to provide excellent customer service and/or Revenue Cycle updates.
Demonstrated sense of compassion and drive to ensure patient(s) and their families receive optimal coverage so they can receive Cambrooke products.
Ability to work independently with minimal direction, take initiative within scope of work responsibilities
Must be a strong team player working with the various Revenue Cycle Teams and be able to initiate activity and/or promptly communicate & mentor others.
Must have great listening skills to work with team members, other colleagues, and outside customers & clinics, to identify and initiate suggestions, guidance and/or resolution.
Must be results and people-orientated having the ability to balance business and relationship considerations.
Knowledge of HIPAA and the ability to maintain confidential information security relative to all company’s proprietary information.

Benefits

Comp & perks

Competitive Pay and Annual Bonus Opportunity
401(k) with Company Contributions
Medical, Dental, and Vision — Effective Day 1
Paid Time Off, Company Holidays, and Floating Holidays
Paid Parental Leave
Wellness Programs and Yearly Wellness Reimbursement
Work Flexibility
Company-Paid Life and Disability Insurance
Employee Assistance Program (EAP)
Tuition Reimbursement Opportunities
Career Growth and Development within a Global Organization
Company-Provided Mental Health and Caregiving support

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical billingeligibility verificationprior authorizationHCPCs codingICD10 codingattention to detailcustomer serviceSalesForceOrder Management SystemMicrosoft Office

Soft Skills

communication skillscompassionteam playerinitiativemulti-taskingprioritizationlistening skillsproblem-solvingorganizational skillsresults-oriented