Clinical Authorization Auditor - LPN/LVN
About The Position
The clinical authorization auditor is an experienced home health LVN/LPN that performs clinical reviews and evaluates the appropriateness of clinical services. This position reviews clinical documentation and makes recommendations for appropriate utilization. The clinical authorization auditor acts as a resource to Enhabit Home Health & Hospice branches and home office with regard to federal, state, and agency regulations for home health and hospice. This is a remote position, but applicant must live in a state that we do business in.
Requirements
- Must be a graduate of an approved school of nursing and a licensed LPN/LVN in the state where they currently practice.
- Must have at least one year experience as a licensed professional.
- Must have demonstrated experience and understanding of federal, state, and local laws and regulatory guidelines governing the operations of Medicare certified home health and hospice.
- Advanced technology skills using computers and mobile devices is a must.
- Must possess a valid state driver license
- Must maintain automobile liability insurance as required by law
Nice To Haves
- Previous experience planning and presenting on educational topics is preferred.
- Demonstrated understanding of OASIS documentation regulations and procedures is highly preferred.
Responsibilities
- Complete clinical record reviews and make recommendations; evaluate the appropriateness of proposed clinical services provided.
- Complete timely follow-up on requested authorizations; utilize Homecare Homebase (HCHB) workflow and address pending requests.
- Maintain communication with branches; insurance carrier contractual or regulatory requirements.
- Review and evaluate branch adherence to the Enhabit Home Health and Hospice compliance program and make recommendations where needed to correct deficiencies; act as a compliance liaison for Enhabit Home Health and Hospice at all times.
- Review and evaluate branch compliance to external regulators and make recommendations where needed to correct deficiencies; Occupational Safety and Heath Administration (OSHA) and other safety regulations, Medicare conditions of participation, and state laws and regulations.
- Assist with resolution of operational and software help issues related to clinical authorizations; ensure task are completed accurately and timely.
- Monitor branch authorization workflow and actions screens in HCHB, as needed.
- Complete all other duties as assigned.
Benefits
- 30 days PDO – Up to 6 weeks (PDO includes company observed holidays)
- Continuing education opportunities
- Scholarship program for employees
- Matching 401(k) plan for all employees
- Comprehensive insurance plans for medical, dental and vision coverage for full-time employees
- Supplemental insurance policies for life, disability, critical illness, hospital indemnity and accident insurance plans for full-time employees
- Flexible spending account plans for full-time employees
- Minimum essential coverage health insurance plan for all employees
- Electronic medical records and mobile devices for all clinicians
- Incentivized bonus plan
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
