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About the Role
Responsible for verifying and obtaining authorizations for home care services, contacting insurance plans for updates, and managing authorization records. This role involves scheduling visits, assisting with billing issues, and collaborating with the Home Care Team to ensure client needs are met.
Responsibilities
- Obtain all initial authorization prior to start of care.
- Run an authorization expiration certification report weekly and follow-up to get expired authorizations via email, fax or phone, and document all communication.
- Communicate with insurance plans daily, and/or as necessary, to attempt to obtain re-authorizations/overtime authorizations.
- Maintain records of all written and verbal correspondence regarding status of obtaining authorizations.
- Track and monitor all authorizations in a timely manner, inform management weekly of authorizations that are due and ensure authorization is obtained.
- Verify all authorizations, ensure completeness and accuracy of information and update computer system with hours, procedure codes and diagnostic codes.
- Schedule all registered nurses and social worker visits in computer system.
- Make referrals to plans as necessary.
- Respond to all requests from contracts/plans for the nurse supervisory visit report to enhance the authorization process.
- Assist the Contract/Plans in obtaining the M11Q from the clients.
- Forward all completed M11Qs to the Contract/Plans.
- Create and maintain a computerized filing system for all authorizations.
- Distribute copies of authorization to the billing department and Case Coordinators.
- Enter all changes of authorized hours into the computer, informing the Case Coordinators of the changes in clients’ hours.
- Collaborate/communicate with the billing department to reconcile authorization gaps or any discrepancies that may be in the authorizations.
- Follow-up on the Hold Report received from the billing department.
- Maintain a log of all social work authorizations, notifying the Clinical Manager, Intake Liaison, and billing department.
- Initiate call backs and follow-up to patients and providers to coordinate and clarify benefits and services.
- Upon completion of inquiries, initiate call back or correspondence to Physicians/Members to coordinate/clarify case completion.
- Collect and collate information required to handle escalated phone/correspondence inquiries.
- Assist with on-boarding and training of new Team Associate.
- Serve as a backup for Intake Coordinator.
- Coordinate Home Care services to new patients, ensuring that the required level and amount of services are provided timely and safely as prescribed by the patient’s plan of care/authorization.
- Collaborate with other members of the Home Care Team in the selection of the first permanent Home Care Worker who is assigned to ensure that the defined unique needs of the new client can be met.
- Perform other duties as required or assigned.
- Adhere to organization’s standards by completing annual mandatory trainings in a timely manner on topics including – but not limited to – Sexual Harassment Prevention Training, IT Security Awareness, Compliance, OSHA, HIPAA and any other training the organization may deem necessary in regards to regulatory compliance or good business practices.
- Support organization’s mission by striving for excellence in all aspects of their job with a focus on positive interpersonal relationship with co-workers.
- Adhere to the organization’s policy in regards to absenteeism and appearance and health and safety standards.
Requirements
- Associate’s degree (A.A.) or equivalent from a two-year college or technical school; a minimum of two year’s related experience; or equivalent combination of education and experience
- Computer literate
- Excellent verbal and written skills
- Excellent customer service skills
- Able to multi-task and work independently with a great attention to detail
- Must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds.
- Occasional exposure to toxic or caustic chemicals.
Skills
- Computer literate
- Excellent verbal and written skills
- Excellent customer service skills
- Attention to detail
Work Type
- Business office environment
Experience Level
- Minimum of two year’s related experience
Education Level
- Associate’s degree (A.A.) or equivalent from a two-year college or technical school
Salary/Compensations
- $26-26.22