Job Description

We are seeking an Insurance Specialist to join our team!   This position will coordinate all components in the Insurance Verification and Authorizations process for existing and new patients as well as working closely with staff.  Prior authorization activities including but not limited to obtaining the appropriate authorizations for home health facility, verification of insurance coverage.

Responsibilities:

• Utilizes current system to conduct insurance verification and authorization validation on scheduled patients to ensure eligibility and that benefits are for accurate claim submission and payment.
• Utilizes the SSI online eligibility verification system, and/or may have to contact the Payer directly via telephone, and/or access payer website.
• Requests pre-authorization for home health services.
• Accurately notate the account with actions taken for pre-certification.
• Ability to gather clinical documentation needed to send to insurance.
• Coordinates Peer-to-Peer reviews with Providers for denied requests.
• Follows up on pending authorization requests in a timely manner.
• Establishes knowledge of major payers needed by consistently reviewing confirmation reports to identify payer rejection issues and executes the payer procedures needed to reduce the occurrence of future rejections.
• Assists management team in providing training, assistance and/or guidance to other staff members in issues related to authorizations.
• Provides information to Manager in identifying possible areas of concern that impact account billing or collections, accurately and in a timely manner.

Qualifications:

• Must have working experience with all payer types: commercial, governmental, Medicare, Medicaid, HMO, etc. and the ability to cross over into different payers.
• Ability to perform independent research prior to seeking management assistance.
• Experience and ability to identify billing or payer edit opportunities.
• Homecare Homebase knowledge preferred.
• Remote work available.
• Home Health experience in authorizations preferred.
• Knowledge in Insurance benefits and authorizations preferred.

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