Intake and Authorization Nurse

5 days ago

Colorado Springs, Colorado, United States Innovive Health Full time
Job Title: Intake and Authorization Nurse - Innovive Health

Job Summary:

Innovive Health is seeking an experienced Intake and Authorization Nurse to join our team. As an Intake and Authorization Nurse, you will be responsible for overseeing the inbound referral and authorization process from first contact to admission. This includes collecting information from referral sources, processing documentation, verifying insurance, confirming patient eligibility, obtaining authorizations, and coordinating patient regulatory documentation.

Responsibilities:

* Coordinates new referrals, resumptions of care, and re-admissions for home health services.
* Promotes and ensures adherence to high levels of communication between referral sources and internal stakeholders.
* Ensures appropriate and timely notifications to referral sources regarding status.
* Obtains all necessary documents, including patient medical history, immunizations, medication lists, and face-to-face documentation.
* Reviews incoming paperwork for compliance with state, federal, and payor regulations.
* Ensures that providers and health systems in the geographic coverage area are in Salesforce to support full referral documentation in the CRM.
* Enters and uploads documentation into the company's electronic medical record (EMR) system, HealthWyse.
* Runs eligibility for new referrals and coordinates issues with the Senior Clinical Documentation Specialist.
* Enters new providers into the system via the MD Request line in HealthWyse and Salesforce.
* Confirms both PECOS and Medicaid program registration of new providers at time of referral.
* Reconciles new providers that require supervision per regulatory standards to their supervising physician in EMR.
* Runs the Physician PECOS list once a week.
* Collects demographic information, checks insurance eligibility, and collects required documentation to ensure regulatory compliance with Medicare and Medicaid.
* Obtains prior authorization or pre-certification of home health services to be rendered as required by each individual payor and single access point in Colorado.
* Serves as an internal resource and consultant to Clinical and the Authorization Department regarding medical necessity documentation, reimbursement, clinical resource utilization, and care coordination issues.
* Assists the authorization department staff with clinical-related questions and assists with formulating appropriate responses to HealthFirst designated PAR entities.
* Reviews assigned denied decisions and reports to the Clinical Director and VP of Strategy with recommendations for future process improvements.
* Adheres to HIPAA laws and maintains patient confidentiality at all times.
* Participates in continuing education, committees, and meetings as required.
* Re-verify patient eligibility, monitor insurance lifetime caps, and prior authorization periods.
* Collaborates with the Senior Documentation Specialist to resolve patient/payor issues in a timely manner.

Requirements:

* Graduate of an accredited school of nursing with a Bachelor of Science in Nursing.
* Currently licensed as an RN in the state of Colorado with no restrictions.
* 3+ years of clinical experience.
* 1+ year of experience in a home health or post-acute setting.
* 1+ year of related experience (intake, referral processes, authorization, etc.).

Preferred Education & Experience:

* 3+ years of related experience preferred.

What We Offer:

* Competitive salary based on experience.
* Comprehensive benefits package including medical, dental, vision, disability, and life insurance.
* 24 days of paid time off.
* Paid Company Holidays.
* 401k with company match.
* Dayforce Wallet - voluntary benefit that gives you access to earned pay.
* Wellness program.
* Tuition reimbursement.
* Online CEU credits.
* Excellent career growth opportunities.

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