Authorization Specialist/Biller

VNA of Care New England•Warwick, RI

About The Position

Job Summary: Accurately prepares edits and submits bills in a timely manner, confirms eligibility, and obtains authorization in accordance with requirement of third-party payers. Conducts related activities to support the efficient operations of the department. Knowledgeable in all aspects of Agency policy and services. Maintains knowledge of all billing, eligibility verification, coordination of benefits, and authorization policies, regulations, rules and reimbursement. Duties and Responsibilities: Obtains accurate and complete insurance coverage information and authorization for services utilizing electronic access when available. Understands prior approval and all authorization requirements and timeframes. Investigates and makes corrections in McKesson. Incorporates all new processes and requirements into daily work as requested. Accurately completes assigned processes. i.e. Au notes CB notes and BN notes as well as Case Communications etc. Enters Information on patients profile in Horizon -Such as Authorization, Copay, deductable, limitations specific to each patients Insurance plan. Proactively tracks and does follow up on authorization requests. Determines insurance eligibility by checking patients with benefits and insurance coverage for services and coordination of benefits Effectively prioritizes own work in order to complete job responsibilities. Displays ability to adjust priorities based upon understanding of policies and procedures. Completes job responsibilities within required timeframe, according to established schedules or workflow requirements. Responsible for running daily reports to capture authorization requirements. Works effectively with others, helping solve problems and promoting teamwork and cooperation among individuals and/or departments. Coordinates and verifies patient information for completeness and accuracy, in a timely fashion; communicates with clinical staff, third-party payers and patients on a regular basis. Verifies required signatures on patients documents, i.e. Patient Client Authorization Form Verifies all insurance data, coordinating benefits, responding to inquiries in a timely manner. Verifies patients insurance coverage and/or pay source, checking that all visits are made within established admission and discharge dates, if applicable. Reviews and checks paperwork visits entered to final bill for accurate date of service, number of visits duplicates; identifies discrepancies, notifies appropriate personnel as needed. Submits claims in a timely manner. Researches payment sources and patient balances to check for co-insurance; follows appropriate steps to transfer balance to co-insurance and/or directly bill the patient. Follows guidelines and procedures for billing self pay, bad debt funding sources. Researches old claims; identifies and resolves any existing problems; refers unusual or difficult problems to Senior Manager of Patient Financial Services as necessary. Reviews, edits, and prepares claims to be submitted; forwards all appropriate information to third-party payers as necessary. Works with Aging Report to decrease days in Accounts Receivables. Understands A/R balances and reimbursement practices. Maintains Excel spreadsheets. Conducts follow-up and collections procedures on each account. Maintains billing files and documentation. Maintains knowledge of all billing policies, rules and regulations. Demonstrates specialized level of knowledge of reimbursement practices and of third party payer contracts. Posts third-party remittance advice accurately with attention to detail. Understands debits and credits. Provides assistance to Senior Manager of Patient Financial Services, i.e, with month-end processes, including financial reports and other requested projects. Prepares, prints and submits all reports, documents and summaries on a regular basis. Utilizes interpersonal communication skills in order to exchange information in a clear and accurate manner within the agency as well as outside. Responsible for follow-up with Manager on all questions/problems discovered and keep Manager informed. Establishes and maintains a work area that is well-organized, clean and net. Operates and maintains equipment carefully and in accordance with procedures. Takes initiative to help maintain commonly-used equipment and work areas. Immediately reports unsafe conditions to appropriate personnel. Performs all other related duties as assigned.

Requirements

High school diploma or equivalent required
Six-months of job-related experience or equivalent required
Demonstrated competency in office/clerical procedures, including typing, professional telephone skills, filing, photocopying and fax operations
Previous experience with various software packages, PCs and database knowledge required
Ability to apply common sense instructions furnished in written, oral, or diagram form
Ability to deal with problems involving several concrete variables in standardized situations
Excellent command of the English language required
Ability to read, analyze and interpret general business reports
Ability to effectively present information and respond to questions from staff and managers

Nice To Haves

Associates Degree in related subject(s) preferred

Responsibilities

Accurately prepares edits and submits bills in a timely manner
Confirms eligibility
Obtains authorization in accordance with requirement of third-party payers
Conducts related activities to support the efficient operations of the department
Maintains knowledge of all billing, eligibility verification, coordination of benefits, and authorization policies, regulations, rules and reimbursement
Obtains accurate and complete insurance coverage information and authorization for services utilizing electronic access when available
Understands prior approval and all authorization requirements and timeframes
Investigates and makes corrections in McKesson
Incorporates all new processes and requirements into daily work as requested
Accurately completes assigned processes. i.e. Au notes CB notes and BN notes as well as Case Communications etc
Enters Information on patients profile in Horizon -Such as Authorization, Copay, deductable, limitations specific to each patients Insurance plan
Proactively tracks and does follow up on authorization requests
Determines insurance eligibility by checking patients with benefits and insurance coverage for services and coordination of benefits
Effectively prioritizes own work in order to complete job responsibilities
Displays ability to adjust priorities based upon understanding of policies and procedures
Completes job responsibilities within required timeframe, according to established schedules or workflow requirements
Responsible for running daily reports to capture authorization requirements
Works effectively with others, helping solve problems and promoting teamwork and cooperation among individuals and/or departments
Coordinates and verifies patient information for completeness and accuracy, in a timely fashion; communicates with clinical staff, third-party payers and patients on a regular basis
Verifies required signatures on patients documents, i.e. Patient Client Authorization Form
Verifies all insurance data, coordinating benefits, responding to inquiries in a timely manner
Verifies patients insurance coverage and/or pay source, checking that all visits are made within established admission and discharge dates, if applicable
Reviews and checks paperwork visits entered to final bill for accurate date of service, number of visits duplicates; identifies discrepancies, notifies appropriate personnel as needed
Submits claims in a timely manner
Researches payment sources and patient balances to check for co-insurance; follows appropriate steps to transfer balance to co-insurance and/or directly bill the patient
Follows guidelines and procedures for billing self pay, bad debt funding sources
Researches old claims; identifies and resolves any existing problems; refers unusual or difficult problems to Senior Manager of Patient Financial Services as necessary
Reviews, edits, and prepares claims to be submitted; forwards all appropriate information to third-party payers as necessary
Works with Aging Report to decrease days in Accounts Receivables
Understands A/R balances and reimbursement practices
Maintains Excel spreadsheets
Conducts follow-up and collections procedures on each account
Maintains billing files and documentation
Demonstrates specialized level of knowledge of reimbursement practices and of third party payer contracts
Posts third-party remittance advice accurately with attention to detail
Understands debits and credits
Provides assistance to Senior Manager of Patient Financial Services, i.e, with month-end processes, including financial reports and other requested projects
Prepares, prints and submits all reports, documents and summaries on a regular basis
Utilizes interpersonal communication skills in order to exchange information in a clear and accurate manner within the agency as well as outside
Responsible for follow-up with Manager on all questions/problems discovered and keep Manager informed
Establishes and maintains a work area that is well-organized, clean and net
Operates and maintains equipment carefully and in accordance with procedures
Takes initiative to help maintain commonly-used equipment and work areas
Immediately reports unsafe conditions to appropriate personnel
Performs all other related duties as assigned