Home Health Insurance Authorization Specialist

CenterWell

1d • $43,000 - $56,200 • Remote

About The Position

This is a full time remote position scheduled 40 hours, 5 days a week for 8 hour shifts. The schedule you will work is Monday-Friday from 9:30am-6pm EST. As a Home Healthcare Insurance Authorization Specialist, you will report directly to the Authorization Supervisor. You will: Daily audit of admission, discharge and other source documentation to ensure revenue is recognized appropriately and all conditions of payment are met. Verify patient eligibility and payor coverage guidelines to ensure that all necessary information is secured for accurate revenue recognition. Weekly generation of site revenue and resolution of batch errors and bill holds. Weekly communication with site leadership detailing outstanding documentation or other issues resulting in a potential loss of revenue. Prepare and submit invoices to Accounts Payable for reimbursement and perform follow up to ensure accurate payments are made to our facility partners. Prepare, submit, and follow up on authorization and re-authorization requests according to applicable state and commercial payor guidelines. Coordinate, review, and analyze documentation and data entry supporting Medicare, Medicaid, and commercial payer requirements to ensure accurate and timely billing. Ensure all internal controls and related policies/procedures are implemented and followed in accordance to the accounts receivable requirements. Ensure all payer requirements are met, including pre-cert requirements, notification requirements, and level of care change required documents. Alerts appropriate team members at the Site regarding late or missing documents required for billing. Establish and maintain positive working relationships with Sites, Nursing Home Facilities, and AR Teams. Maintain the confidentiality of patient/client and agency information. Maintain accurate and up to date information for all vendor and nursing facility contracts. Keep information in an orderly manner accessible for review. Present status as requested. Assure compliance with local, state and federal laws, Medicare regulations, and established company policies and procedures. Participate in special projects and perform other responsibilities as assigned. Help train newly-hired associates, as well as re-education of revenue teams. Information resource for any hard revenue generation issues or system issues. Basically the subject matter expert. Assure the completion and coordination of work in an associate's absence, or when needed to maintain departmental standards. Use your skills to make an impact

Requirements

• Proficient in using computers and Microsoft Office applications, including Word, Excel, and Outlook.
• Self-provided internet service must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• One or more years of insurance authorization and/or training experience preferred.
• Two or more years of home healthcare or medical office experience preferred.
• Knowledge of insurance reimbursement process preferred.
• Two years college preferred.

Responsibilities

• Daily audit of admission, discharge and other source documentation to ensure revenue is recognized appropriately and all conditions of payment are met.
• Verify patient eligibility and payor coverage guidelines to ensure that all necessary information is secured for accurate revenue recognition.
• Weekly generation of site revenue and resolution of batch errors and bill holds.
• Weekly communication with site leadership detailing outstanding documentation or other issues resulting in a potential loss of revenue.
• Prepare and submit invoices to Accounts Payable for reimbursement and perform follow up to ensure accurate payments are made to our facility partners.
• Prepare, submit, and follow up on authorization and re-authorization requests according to applicable state and commercial payor guidelines.
• Coordinate, review, and analyze documentation and data entry supporting Medicare, Medicaid, and commercial payer requirements to ensure accurate and timely billing.
• Ensure all internal controls and related policies/procedures are implemented and followed in accordance to the accounts receivable requirements.
• Ensure all payer requirements are met, including pre-cert requirements, notification requirements, and level of care change required documents.
• Alerts appropriate team members at the Site regarding late or missing documents required for billing.
• Establish and maintain positive working relationships with Sites, Nursing Home Facilities, and AR Teams.
• Maintain the confidentiality of patient/client and agency information.
• Maintain accurate and up to date information for all vendor and nursing facility contracts.
• Keep information in an orderly manner accessible for review.
• Present status as requested.
• Assure compliance with local, state and federal laws, Medicare regulations, and established company policies and procedures.
• Participate in special projects and perform other responsibilities as assigned.
• Help train newly-hired associates, as well as re-education of revenue teams.
• Information resource for any hard revenue generation issues or system issues.
• Assure the completion and coordination of work in an associate's absence, or when needed to maintain departmental standards.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree