Director of Insurance

4 weeks ago

Washington, United States Graham Healthcare Group Full time

**Summary**:
Manage the Insurance Verification and Authorization (IV&A) team to ensure that benefit information, initial authorization, and patient liability are obtained prior to the clinical staff starting patient care. Ensure that the Insurance Verification and Authorization team complete tasks associated in the EMR system (HomeCare HomeBase) Insurance Verification and Authorization workflow. Create and maintain policies and procedures for utilization management review, optimize staffing workflow, analyze performance trends, and generate comprehensive reports on prior authorization/appeal metrics.

**Essential Duties and Responsibilities**:
include the following. Other duties may be assigned as necessary.

Oversee daily department functions, including but not limited to:

- Obtain detailed and accurate benefit information using websites or phone for all insurance companies accepted by the company and for all product lines
- Validate and document all payer information such as patient name, DOB etc. in the system
- Clearly document benefit information such as deductibles and out-of-pocket maximums in patient chart
- Daily/continuous monitoring of task flow screen related to all insurance issues including but not limited to: verify Medicare eligibility, complete insurance verification, review eligibility alerts, obtain initial authorization, re-verify insurance at recertification and resumption of care
- Assist intake department, discharge planners, and referral sources with contracted insurance issues and patient placement
- Contact physician offices or patients for information or to clarify benefits
- Assist scheduling department with funding source problems related to synching visits to clinical staff
- Assist billing department insurance verification or authorization discrepancies which could hold up claim submission
- Monitors and ensures all client authorization of services are current and quantity and type of services provided meet payer requirements

Additional duties:

- Establish a thorough knowledge of all payer portals used by the IV & A Team
- Work with Senior Leadership to develop and implement strategic initiatives to improve the overall effectiveness of the prior authorization services
- Perform investigative evaluation of process improvement initiatives including but not limited to, cost/benefit analysis, process analysis, data analysis, solutioning and implementation
- Develop and document process design that incorporates automation where applicable and coordinate user acceptance testing
- Collaborate with vendors on product offerings and monitor usage and return on investment
- Monitor timeliness and effectiveness of department activities using internal benchmarking and industry standards using reporting tools
- Ensure that all staff comprehend and comply with professional standards and internal processes and procedures
- Monthly review of any claims proposed for write-off
- Lead Monthly IV&A Team Meeting
- Develop department reporting metrics to measure timeliness and effectiveness of department functions
- Prepare reports as requested by management
- Maintain professional, positive and effective communication with payers, clients, Corporate, and branch employees
- Follow all Policies & Procedures
- Comply with the company's Core Values and Core Competencies
- Perform other duties as assigned

**Qualification Requirements**:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Associate degree or related medical business courses or a combination of schooling and experience
- Minimum of three to five years in the medical industry
- Supervisory experience preferred
- Ability to think critically and act independently when resolving benefit discrepancies
- Proficiency in Microsoft Office Suite
- Knowledge of Medicare
- Knowledge of insurance websites such as web-DENIS,Champs,Priority Health,etc.
- Knowledge o fHome Care Home Base preferred
- Conscientious,with attention to detail
- Demonstrate patience,flexibility,and cooperative attitude
- Excellent verbal and written communication skills with others both internally and externally
- Ability to lead and manage a team

**Education and/or Experience**:

- Bachelor’s degree with emphasis in finance preferred

**Certificates, Licenses, Registrations**:
Must have and maintain in good standing professional license, certificate, or registration, as applicable.

**Physical Demands**:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of t

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