Home Care Billing Specialist

Valence Care - HCS - Girling NY - Extended Home Care - A&J Staffing - A Better Life - Direct Care•New York, NY

23d•$24 - $26

About The Position

Liaise between Extended Home Care clinical staff and all Managed Care contracts to facilitate the timely receipt and processing of authorizations for patient services. Provide supervision and oversight to the HMO Department and HMO Specialists in effectively managing the processing of authorization requests and denials.

Requirements

Associate degree or five years relevant work experience required, Bachelor’s Degree preferred.
Minimum of two years’ experience working with HMOs and/or Commercial Health Insurances and knowledge of Managed Care regulations.
Ability to work cooperatively with others, work as part of a team and support team decisions, collaborate with others and solve problems independently.
Ability to manage a team of individuals and provide oversight of direct reports’ daily assignments and work performance.
Ability to communicate effectively both verbally and in writing.
Strong organizational and prioritization skills relating to efficient and effective processing of requests for authorizations and submission of clinical reports
Knowledge of Outlook, Excel, Word and other applications.
Familiarity with McKesson or other EMR platforms.

Nice To Haves

Previous Home Care Experience is a Plus
Previous experience working in a supervisory capacity preferred.

Responsibilities

Work with EHC Case Managers/COC’s and Clinical Managers to formulate requests for services from Managed Care contracts and HMO’s.
Obtain and maintain authorizations for the HMO Department
Create formal authorization requests based on clinical information submitted in verbal reports, visit notes, orders, coordination notes, SOC notes, diagnosis, medications, etc.
Generate and print Managed Care Request Forms from the Horizon/McKesson software system to be sent to Managed Care and HMO contract in a timely manner.
Liaise between Managed Care and HMO contracts and EHC to provide updates on authorized services and/or denials
Answer and return calls from Managed Care and HMO contracts providing verbal authorizations by phone.
Enter authorization determinations received verbally, electronically and via fax into the Horizon/McKesson software system.
Confirm authorization numbers, time frames and approved/denied/disregarded services with Managed Care and HMO contract’s Medical Management Department.
Follow up with Clinical Team to cross check and verify the number of visits made with the number of visits approved to determine the need for a request for additional services.
Organize pending authorization requests by Insurance carrier, date and time sensitivity.
Follow-up on previously requested authorizations not received in a timely manner.
Enter notations in McKesson regarding authorization delays/status or other pertinent information.
Send the Case Managers notification/reminders of authorization determinations via the Horizon/ McKesson software system, Outlook Email and Outlook Calendar for each patient.
Assist the billing department with authorization discrepancies and reconcile monthly reports.
Maintain an updated contact list of all Managed Care and HMO’s authorization department contacts and care managers and endeavor to build strong relationships with them to facilitate timely responses.
Provide direct supervision to all HMO Specialists and provide coverage of their assigned responsibilities in the event of an unscheduled absence or emergency.
Resolves issues and problems encountered in day-to-day operations of the HMO Department.
Coordinates staffing of day-to-day activities as well as assigns and monitors work of staff in order to adhere to productivity and quality standards.
Determines work procedures, prepares work schedules, and expedites workflow.
Coordinates staffing day-to-day activities as well as assigns and monitors work performance of staff.
Provide weekly/monthly reports to the DPS
Provides other duties as prescribed.
Demonstrates sound judgment by taking appropriate actions regarding suspected violations of corporate compliance regulations
Reports all suspected violations to supervisor, Compliance Officer or Compliance Hotline.