Authorization Coordinator

Signature Healthcare at Home•Tigard, OR

About The Position

JOB SUMMARY Responsible for verifying benefits for home care services and hospice services, which includes establishing and maintaining positive relationships with insurance case managers and related referral sources. Responsible for requesting and documenting ongoing authorizations required for Home Health and Hospice services and communicating this information effectively to clinicians and office staff. DUTIES & RESPONSIBILITIES Verifies insurance coverage and obtains initial authorizations for services as needed and seeks reauthorization for ongoing and additional services. Documents verification of benefits and requests for ongoing services into electronic medical records system. Verifies Hospice Benefit Period and documents in electronic medical record. Works with Clinical Manager and staff clinicians to gather and report patient care summary information to insurance company representatives as requested. Maintains comprehensive working knowledge of managed care contractual relationships and ensures that patients are admitted and services are delivered in accordance with contract provisions. Works with billing staff to keep insurance contract information updated for intake/admissions staff. Works with members of the billing team to ensure that patients are billed according to contracts, providing information as requested to ensure timely billing. Establishes and maitains positive working relationships with current and potential insurance contacts. Promptly responds to insurance representatives’ requests and concerns and documents progress in the electronic medical record. Clearly communicates requests/limitations of authorizations to clinicians and office staff/scheduling for planning of patient care. Assists in building community, customer, and payer and patient perceptions of Connected Home Health & Hospice as a high quality provider of services. Maintains comprehensive working knowledge in the field of managed care and shares information with appropriate organization personnel. The above statements are only meant to be a representative summary of the major duties and responsibilities performed by the employee of this job. The employee may be requested to perform job-related tasks other than those stated in this description.

Requirements

At least three years of experience in health care managed care coordination, preferably in home health care.
Complies with acceptable professional standards and practice.
Knowledge of corporate business management and managed care environment.
Demonstrates good communication and public relations skills.
Demonstrates autonomy, organization, assertiveness, flexibility, and cooperation in performing job responsibilities.

Responsibilities

Verifies insurance coverage and obtains initial authorizations for services as needed and seeks reauthorization for ongoing and additional services.
Documents verification of benefits and requests for ongoing services into electronic medical records system.
Verifies Hospice Benefit Period and documents in electronic medical record.
Works with Clinical Manager and staff clinicians to gather and report patient care summary information to insurance company representatives as requested.
Maintains comprehensive working knowledge of managed care contractual relationships and ensures that patients are admitted and services are delivered in accordance with contract provisions.
Works with billing staff to keep insurance contract information updated for intake/admissions staff.
Works with members of the billing team to ensure that patients are billed according to contracts, providing information as requested to ensure timely billing.
Establishes and maitains positive working relationships with current and potential insurance contacts.
Promptly responds to insurance representatives’ requests and concerns and documents progress in the electronic medical record.
Clearly communicates requests/limitations of authorizations to clinicians and office staff/scheduling for planning of patient care.
Assists in building community, customer, and payer and patient perceptions of Connected Home Health & Hospice as a high quality provider of services.
Maintains comprehensive working knowledge in the field of managed care and shares information with appropriate organization personnel.