Home Health Insurance Authorization Specialist

Role Overview

• Daily audit of 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 that all necessary information is secured for timely, accurate revenue recognition.
• Weekly generation of site revenue and resolution of batch errors and bill holds as appropriate.
• Weekly communication 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 performs 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 to the accounts receivable requirements.
• Ensure all payer requirements are met accordingly, including pre-cert requirements, notification requirements, and level of care change required documents.
• Alerts 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.
• 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 for compliance with local, state and federal laws, Medicare regulations, and established company policies and procedures.
• Participate in special projects and performs 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.

Requirements

• One or more years of related experience and/or training preferred.
• Two or more years of Home Healthcare or Medical Office experience preferred.
• Knowledge of insurance reimbursement and authorization process preferred.
• Proficient in using computers and Microsoft Office applications, including Word, Excel, and Outlook.
• Two years college preferred.

Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance