Eligibility and Authorization Specialist - Home health

Job Overview

Responsibilities

• Review and process authorization requests for home health services, ensuring all documentation aligns with payer requirements.
• Verify patient insurance coverage accurately, including eligibility, benefits, and authorization limits across various managed care plans.
• Collaborate with medical providers, case managers, and insurance companies to obtain necessary authorizations and resolve any discrepancies.
• Maintain detailed records of all authorization activities in accordance with HIPAA regulations to ensure confidentiality and data security.
• Utilize medical coding knowledge, including CPT (Current Procedural Terminology), ICD-9, ICD-10, and ICD coding systems, to support accurate documentation and billing processes.
• Assist in the review of medical records to confirm that documentation supports the services being authorized.
• Stay informed about changes in insurance policies, managed care guidelines, and healthcare regulations to ensure ongoing compliance.

Requirements

• Proven experience in managed care or medical office settings, preferably within home health or outpatient services.
• Strong knowledge of medical terminology, medical records management, and medical coding practices including CPT, ICD-9, ICD-10, and ICD coding systems.
• Familiarity with HIPAA regulations to ensure patient privacy and data security at all times.
• Experience with insurance verification and authorization processes across various insurance providers and managed care plans.
• Office experience that demonstrates organizational skills and attention to detail in a fast-paced environment.
• Knowledge of dental office procedures is a plus but not required; however, familiarity with healthcare billing or coding is essential.
• Excellent communication skills for effective collaboration with healthcare providers, insurance companies, and patients.