Home Health and Hospice Authorization Representative

Job Essentials

Obtains insurance eligibility and benefit information using various phone and on-line resources.

Obtains appropriate authorizations and notifies insurance companies of patient arrival as needed.

Works with Utilization Review staff and/or physicians' offices to assure eligibility and authorization requirements are completed within the required timeframe.

Communicates with the appropriate nursing and/or billing staff when changes are made to the account that will affect the reimbursement.

Makes appropriate corrections in the patient's record to ensure accuracy in order to prevent denials and/or problems with billing and reimbursement.

Immediately refers 'at risk' admissions to eligibility, i.e., out of network, underinsured, max benefits, etc.

Works with insurance eligibility responses and other appropriate reports and works with physicians and patients as needed to resolve issues and prevent billing delays.

Maintains a satisfactory level of performance and adherence to workload standards.

Estimates cost of service using ICD-9 or CPT codes.

Interprets 271 response, including insurance terminology, in online tool to determine patient responsibility.

Performs calculations using insurance benefit information to accurately estimate patient responsibility.

Qualifications

• Demonstrated experience utilizing Epic and other electronic medical record (EMR) systems.
• Working within a clinical healthcare setting.
• Managing claims and appeals processes.
• Two years of customer service experience.
• Demonstrated good communications and computer skills.

Preferred Qualifications

• Demonstrated knowledge of medical terminology.
• Experience in admitting, billing, collections, and/or insurance verification.
• Bi-Lingual Spanish speaking.
• Demonstrated knowledge of CPT/ICD-9 codes.
• Strong experience with EPIC and EMR.
• Experience working in a clinical setting.
• Experience with claims and appeals.
• Interacts with others requiring the employee to communicate information.
• Operates computers and other office equipment requiring the ability to move fingers and hands.
• Remains sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Benefits

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.