Authorization Specialist Lead II (Prebilling, Insurance, Payor Contracts) - HomeCare

Hartford HealthCare•Farmington, CT

1d•Hybrid

About The Position

Every day, almost 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. Hartford HealthCare at Home, the largest provider of homecare services in Connecticut, has been fulfilling our mission for more than 115 years. Our Person-Centered Care Model allows our employees to learn and grow within our organization, all while providing integrated support to the patient. As part of Hartford HealthCare, we leverage cutting edge technology to provide quality care in our client’s home. Most importantly, our employees are appreciated for the real differences they make in both the lives of their clients and their clients’ families. The Home Health and Hospice Authorization Specialist Lead 2 entails supporting the Prebilling and Authorization Manager in training, payor updates and identifying metrics around eligibility and authorizations. Ensuring accurate and timely processing of patient insurance verifications and prior authorization requests, by reviewing submitted information, resolving complex cases, and maintaining quality standards within the established payor guidelines. The position requires strong knowledge of payor contracts, insurance authorization requirements, and excellent communication skills to effectively interact with branches, team members, and payors. Verify insurance eligibility and authorization requirements for Home Health and Hospice clients in a timely manner according to payor specific guidelines. High focus on accuracy and productivity to meet established metrics. Communicate payor eligibility and authorization information to all necessary parties within the department and branch. Ability to work independently as well as within the Team environment. The Authorization Specialist Lead 2 is part of a fully remote team with the possibility of being onsite as needed. Need to be able to interpret insurance specifics and recognize how to enter information correctly. Assists Prebilling and Authorizations Manager in identifying QARs (Quality Assurance Reviews) upon request, identify inaccuracy within accounts leading to possible bad debt. Assist in additional training and support with other Authorization Specialists upon request from Prebilling and Authorizations Manager.

Requirements

High School Diploma required.
One year of experience within a healthcare setting and familiarity with payor sources and processes required.
Strong written and verbal English communication skills are necessary.
Knowledge of third party payor regulations including Medicare, Assistance, Veterans Affairs (VA) and private insurance.
Ability to promote and maintain a positive attitude and encourage others to do the same.
Strong organizational skills and the ability to work independently with minimal supervision.
Demonstrates ability to make appropriate judgements as it relates to the payor authorization process.
Basic computer skills with the ability to learn new software.

Nice To Haves

Two – four years’ experience within a healthcare setting and familiarity with payor sources and processes preferred.
Knowledge of Word and Excel a plus.

Responsibilities

Verifies insurance eligibility and requests authorization of current and potential home care clients in an accurate and timely manner.
Communicates payor authorization and eligibility information to Clinical Manager, Business Manager or designee.
Enters insurance authorization and eligibility information according to payor specific guidelines.
Notifies branches regarding lack of payor coverage or other service non-coverage issues.
Performs re-authorization and eligibility checks in a timely manner.
Communicates and documents information regarding change in authorization and eligibility to branch management.
Monitors and ensures all client authorization of services are current and quantity and type of services provided meet payor requirements.
Reviews and ensures appropriate processing of authorizations.
Sends informational correspondence to payor.
Maintains professional, positive and effective communication with payors, clients, Corporate and branch employees.
Maintains confidentiality of all information pertaining to clients, families, and employees.
Consults with branch management and clinical employees.
Participates in the after hours on-call process to assure client care policies and procedures are followed and staffing issues are resolved on a rotation basis.
Performs other related duties and responsibilities as assigned by Prebilling and Authorizations Manager.
Establishes performance expectations of staff, coaches, develops, and mentors by evaluating performance.
Leads workflows to ensure maximum productivity and quality standards.
Keeps Revenue Cycle resources and other key leaders in the OSO apprised of problems/concerns/delays within authorization department on a timely basis.
Stays up to date with industry trends and best practices in billing requirements as related to Authorization.
Leads or serves on recurring workgroups and special projects.