Home Health Authorization Specialist
2 months ago
Assumes day-to-day responsibility processing insurance authorizations and assists on daily insurance benefits coverage verifications for patient admissions in conformance with agency policies and procedures.
JOB DUTIES/RESPONSIBILITIES:
- Demonstrate professional conduct and ethics according to agency policy and procedure.
- Maintain confidentiality of patient information and all Agency operations.
- Provide assistance processing all incoming patient insurance benefits coverage verification referrals from physicians and acute/non-acute facilities.
- Screen insurance benefits coverage verification referrals for admission to home health services based on agency policies and procedures.
- Verify Medicare benefit eligibility through on-line Direct Data Entry (DDE) checks; and if necessary, confirm beneficiary's status with other agencies by phone.
- Coordinate completion of prior authorization and re-authorizations with insurance companies.
- Troubleshoot authorization related issues and follow up status of authorization and any additional documentation or information, if needed.
- Enter current authorizations and respond to internal/external inquiries relating to authorizations.
- Communicate medical complexity/acuity of pre-authorization and re-authorizations requested documentation from insurance companies to the Clinical Coordinator and Scheduler.
- Operate Wellsky, DDE, ECIN on-line to internet as needed; Fax, copy, etc.
- Assist with scanning insurance benefits coverage, pre-authorization and re-authorizations paperwork into the Wellsky system as needed.
- Maintain ongoing communication with other members of the care team on pre-authorization and re-authorization updates
- Maintain ongoing communication with billing team on pending authorizations and troubleshooting authorizations related issues.
- Perform other job duties and responsibilities as assigned by the Home Health Director of Revenue Cycle including participating in performance improvement activities, i.e., performance improvement groups.
POSITION QUALIFICATIONS/REQUIREMENTS:
- At least one (1) year authorization experience preferred with Home Health.
- At least one (1) year insurance benefits coverage verifications experience preferred with Home Health.
- Able to work autonomously with minimum supervision.
- Demonstrated organizational skills and detail-oriented.
- Demonstrated problem-solving and decision-making skills.
- Demonstrated computer skills preferred.
- Demonstrated time management skills.
- Demonstrated interpersonal skills.
- Demonstrated verbal and written communication skills.
- Able to communicate in English.
- Able to work as a team member.
- Ability to manage time effectively in a hybrid work environment.
Empath Health values diversity as it strengthens our community and care. We embrace the diversity of cultures, thoughts, beliefs and traditions of our employees, volunteers and people we are honored to serve across our network. Our diverse staff reflects our community and each day, we work to be respectful, sensitive and competent with each other and those in our care. In every journey, we are dedicated to achieving comfort, dignity and exceptional care. Those of all backgrounds are welcome and encouraged to apply with us or seek our care and services.
Our commitment to patient, client, staff and volunteer safety is a cornerstone of a High Reliability Organization with a focus on zero harm. Participation in the seasonal influenza program is a condition of employment and a requirement for all Empath Health employees.
Providing compassionate, full life care is an honor we take seriously at Empath Health. Join our team and make a positive impact in the community
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