Healthcare Authorization Specialist

3 weeks ago

Atlanta, Georgia, United States CenterWell Full time
Job Summary

We are seeking a skilled Healthcare Authorization Specialist to join our team at CenterWell Home Health. As a key member of our revenue cycle team, you will play a critical role in ensuring timely and accurate revenue recognition for our patients.

Key Responsibilities
  • Audit admission, discharge, and other source documentation to ensure revenue is recognized appropriately and all conditions of payment are met.
  • Verify patient eligibility and payor coverage guidelines to ensure all necessary information is secured for timely, accurate revenue recognition.
  • Generate site revenue and resolve batch errors and bill holds as appropriate.
  • Communicate with site leadership detailing outstanding documentation or other issues resulting in a potential loss of revenue.
  • Prepare and submit invoices to Accounts Payable for reimbursement and perform follow-up to ensure accurate, timely payments are made to our facility partners.
  • Prepare, submit, and follow up on authorization and re-authorization requests according to applicable state and commercial payor guidelines.
  • Coordinate, review, and analyze documentation and data entry supporting Medicare, Medicaid, and commercial payer requirements to ensure accurate and timely billing.
  • Ensure all internal controls and related policies/procedures are implemented and followed in accordance with the accounts receivable requirements.
  • Ensure all payer requirements are met accordingly, including pre-cert requirements, notification requirements, and level of care change required documents.
  • Alert appropriate team members at the Site regarding late or missing documents required for billing.
  • Establish and maintain positive working relationships with Sites, Nursing Home Facilities, and AR Teams.
  • Maintain the confidentiality of patient/client and agency information at all times.
  • Maintain accurate and up-to-date information for all vendor and nursing facility contracts.
  • Keep information in an orderly manner readily accessible for review. Presents status as requested.
  • Assure compliance with local, state, and federal laws, Medicare regulations, and established company policies and procedures.
  • Participate in special projects and perform other duties as assigned.
  • Assist with training of newly-hired associates, as well as re-education of revenue teams as necessary.
  • Act as an information resource for any hard revenue generation issues or system issues. Basically the subject matter expert.
  • Assure the completion and coordination of work in an associate's absence, or as needed to maintain departmental standards.
Requirements
  • One to two years related experience and/or training preferred.
  • Two years Home Health care or Medical Office experience preferred.
  • Knowledge of insurance reimbursement and authorization process preferred.
  • Skilled in the use of computers and the Microsoft Office applications.
  • HealthCare System knowledge is preferred.
  • Two years college preferred.
Benefits

CenterWell Home Health offers a competitive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, company and personal holidays, volunteer time off, paid parental and caregiver leave, short-term and long-term disability, life insurance, and many other opportunities.

We are an equal opportunity employer and welcome applications from diverse candidates. We are committed to creating a workplace that is inclusive and respectful of all employees.

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