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Intake Insurance Specialist

1 month ago

Goldsboro, United States 3HC HOME HEALTH & HOSPICE CARE INC Full time
Job DescriptionJob Description

3HC Home Health and Hospice

Intake Insurance Specialist

Hybrid Position: Local to Goldsboro, North Carolina


Summary:

The Intake Insurance Specialist is responsible for following established procedures and prioritizing workflow to ensure insurance benefits are verified, preauthorization requirements are confirmed, and authorization is requested at the correct time points. The Intake Insurance Specialist supports 3HC processes by ensuring documentation is completed timely, accurately, and efficiently while fostering relationships with internal and external customers. The Intake Insurance Specialist will ensure that 3HC financial viability is secured at this level of the referral process.


Essential Functions:

1) Abides by and supports 3HC's Compliance Program and Code of Ethics. 3HC's Compliance motto is "Compliance for all and all for Compliance."

Performance Expectation:

· It is the intent of 3HC to comply with all applicable laws and regulations, and that spirit is embedded in all aspects of our services and business practices. Our success hinges on doing things ethically and legally, to which each employee plays a critical role.

· HIPAA: Intake staff will only access the patient information needed to perform agency job responsibilities. Intake staff will not show, tell, or otherwise release any information obtained from a patient’s medical record if not within agency HIPAA guidelines.

2) Creates positive experiences for internal and external customers that will meet their expectations. External customers include our patients, families, referral sources, vendors, the community, etc. Internal customers are the people within the agency with whom you work. Performance Expectation:

· Displays a high degree of courtesy and tact in all contact with staff, patients, and visitors.

· Communicates professionally in all conversations, to include in-person, phone, and electronic communications.

· Maintains a sufficient level of knowledge of the agency’s provided services, accepted payors, and service areas.

· Proactively stays abreast of changes in agency policies, protocols, and acceptance criteria.

3) Responsible for the insurance process.

Performance Expectation:

· Ensures insurance benefits are verified, preauthorization requirements are confirmed, and authorization is requested at the correct time points, per regulatory guidelines.

· Communicates clearly, professionally, and timely with patients. Our patients should be notified verbally and in writing how their services are reimbursed per regulatory guidelines.

· regulatory guidelines. This is accomplished by:

1. Verification of benefits for the services being rendered,

2. Documentation of the benefits on the 3HC insurance form so that the admitting clinician may review the insurance form with the patient on admission. A copy of the form is then mailed to the patient by designated 3HC staff.

3. When potential out of pocket expenses apply, Intake Insurance should make every effort to notify the patient or patient representative of this information prior to the start of care and document accordingly. Documentation should also include unsuccessful attempts to reach the patient if unable to discuss prior to the start of care.

· All documentation is completed timely and accurately to include dates of the documentation entries. Library text should be utilized for payer plan notes, and authorization note documentation should be up to date, clear, and precise.

· Communicates timely with Intake and other departments regarding authorization and insurance coverage issues.

· Maintains expert knowledge of partnerships and assists the Intake team with completing the referral process to meet partnership expectations.

· Ensures batch errors related to the Intake process are cleared on the same day of notification. Monitors for batch error trends and collaborates with the team to eliminate the batch error cause.

· Follows-up with patients as needed to assist in answering any benefit-related questions.

· Ensures follow up responsibilities are completed as assigned.

· Maintains awareness of Insurance guidelines related to 3HC service lines and informs the Intake team when made aware of new or changing guidelines.

· Utilizes the chain of command as needed for complex referrals, questions, or various decision-making needs.

· The Intake Team Manager RN serves as the Tier I resource for the team.

· Escalates any issues unable to be addressed by the Intake Team Manager to the Tier II resource person (Director of Intake or the Administrator on-call, as appropriate after regular business hours).

4) Supports the department with effective staffing to ensure the insurance processes and Intake related duties are adequately completed.

Performance Expectation:

· Rotates weekend, holiday, or emergency call as needed.

· Ensures overtime is warranted and approved.

· Ensures time off requests are submitted in advance, work is completed, and any follow up needs are relayed to the team.

· When unexpected absences occur, employee will relay to the team known workflow tasks that need to be completed by Intake during the absence.

· Supports the department when Intake is experiencing a high volume of incoming calls with limited staff by assisting with answering calls.

5) Demonstrates an interest in personal and professional growth.

Performance Expectation:

· Attend all office staff meetings and/or review minutes and sign off review and understanding.

· Complete all agency mandatory education

· Keep abreast of rules and regulations related to essential job functions.

· Accepts constructive criticism from the leadership team, including the Intake Team Manager, and puts forth an effort to show improvement with a positive attitude.

6) Demonstrates a willingness to be cost effective in the use of agency resources, the monitoring of waste, and the proper and safe use of supplies and equipment.

Performance Expectation:

· Maintains knowledge of 3HC and Intake policies, protocols, and processes so that the referral process is consistent and smooth.

· Uses chain of command to support efficiency in communication.

· Utilizes electronic processes for printing and faxing whenever possible (i.e., PDF Binder application, fax2mail application) to minimize paper waste.

· Ensures all electronic accounts remain active by periodically logging into all applications, software, and referral management systems related to job responsibilities. Secures and does not share usernames and passwords for these systems to ensure patient privacy and compliance with the 3HC Compliance Program.

7) Adheres to 3HC's Personnel Policy and performs other duties as assigned by supervisor.

Performance Standard:

· Demonstrates knowledge of when/how to access the agency personnel policy.

· Demonstrates adherence of the agency personnel policy.

· Demonstrates performance of other duties assigned by supervisor.


Qualifications:

Minimum of 2 years of education or experience related to insurance verification/authorizations required, healthcare related preferred.

Robust communication and interpersonal skills

Excellent time management and prioritization skills

Able to work independently and seek out resources to problem solve

Strong computer skills and experience with various medical record systems preferred

Must work effectively in teams setting


3HC is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex or sexual orientation, age, marital status, gender identity, national veteran or disability status.