Home Health Insurance Authorization Specialist

CenterWell

1d • Remote

About The Position

Become a part of our caring community This is a remote full time position scheduled for 8 hour shifts, 5 days a week Monday-Friday from 9am-5:30pm CST / 10am-6:30pm EST. As a Healthcare Insurance Authorization Specialist, you will report directly to the Authorization Supervisor and be responsible for: 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 timely, accurate revenue recognition Weekly generation of site revenue and resolution of batch errors and bill holds as appropriate. 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 performs follow up to ensure accurate, timely 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 accordingly, 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 readily accessible for review. Presents status as requested. Assure for compliance with local, state and federal laws, Medicare regulations, and established company policies and procedures. Participate in special projects and performs other duties as assigned. Assist with training of newly-hired associates, as well as re-education of revenue teams as necessary. Act as an 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 as needed to maintain departmental standards. Use your skills to make an impact

Requirements

• One or more years of related experience and/or training preferred.
• Proficient in using computers and Microsoft Office applications, including Word, Excel, and Outlook.
• To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees 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.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• Two or more years of Home Healthcare or Medical Office experience preferred.
• Knowledge of insurance reimbursement and authorization 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 timely, accurate revenue recognition
• Weekly generation of site revenue and resolution of batch errors and bill holds as appropriate.
• 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 performs follow up to ensure accurate, timely 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 accordingly, 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 readily accessible for review.
• Presents status as requested.
• Assure for compliance with local, state and federal laws, Medicare regulations, and established company policies and procedures.
• Participate in special projects and performs other duties as assigned.
• Assist with training of newly-hired associates, as well as re-education of revenue teams as necessary.
• Act as an 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 as needed to maintain departmental standards.

Benefits

• Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
• Among our benefits, Humana provides medical, dental and 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 and many other opportunities.

What This Job Offers

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