Insurance Authorization Specialist

Insurance Authorization Specialist

Find Your Passion and Purpose as a Insurance Authorization Specialist

Reimagine Your Career in Corporate Healthcare

As a professional, you know that what you do impacts you as much as our patients and their families, and at AccentCare, we are united in our relentless drive to reimagine care because we want to provide the service we would seek for our own families. We think it's really special to be a part of our patient's health journey and create incredible memories while providing world-class patient care.

Offer Based on Years of Experience

What You Need to Know

The Insurance Authorization Specialist is responsible for verifying insurance coverage completed is accurate and appropriate following set operating procedures and job aids provided, responsibilities include the submission, follow up and clinical review of needed services by payor assignment for in home services to ensure payment for services is received. Specialists must adhere to payor guidelines and requirements for timely submission, work with payor case managers on clinical documentation needs and review with timely follow up around assigned patient volume.

Key Responsibilities:

• Provides positive customer service to all external and internal customers. Reviews initial insurance information entered into the electronic medical record by an TPAC/Operations/Sales, to determine the next steps in obtaining ongoing authorizations, when appropriate.
• Request authorization for in-home services for clients referred to home care services on or before SOC when appropriate.
• Communicate with appropriate branch personnel to obtain clinical information needed to submit to the client's insurance carrier for authorization consideration when not readily available in EMR.
• Contacts payor sources to verify insurance coverage, benefits, and patient financial responsibility regarding home care services at start of care, recertification or when a new insurance plan has become effective.
• When obtaining subsequent authorization(s) determines if there are changes in the client's financial liability for continued services, alerting operations to any changes and next steps.
• Enters client authorization information into EMR once an authorization/denial is obtained, as appropriate, to facilitate communication among the home care team. Following standard operation procedure and job aids provided.
• Communicate with the branch team, as needed, to resolve concerns regarding a client's eligibility or authorization.
• Monitors and completes assigned electronic workflow as assigned in the software solution, completing all assigned client related tasks as set within standard operating procedure.
• Routinely reviews coordination notes in the software solution and takes appropriate action, as needed.
• Communicates authorization issues with Operations, and/or Sales, and their manager, as appropriate.
• Receives and follows through on calls from insurance companies pertaining to insurance authorization's needs and or additional clinical documentation required.
• Assist Sales/Operations with any questions regarding the verification or authorization process.
• Follow up on outstanding verification or authorizations to ensure resolution.
• Comply with applicable legal requirements, standards, policies and procedures including, but not limited to the Compliance Program: Code of Conduct, HIPAA and Documentation Standards.
• Maintains a commitment to the values and mission of Accent Care.
• Performs other related duties as assigned.

Education:

Minimum high school diploma or equivalent

Experience: One+ years' experience in home healthcare, preferred One+ years' experience with insurance payors, portals & guidelines

Our Investment in You

• Medical, dental, and vision coverage
• Paid time off and paid holidays
• Professional development
• Company-matching 401(k)
• Flexible spending and health savings accounts
• Company store credit for your first AccentCare-branded scrubs for patient-facing employees

Why AccentCare?

Come As You Are

At AccentCare, our care is most compassionate when we empathize and engage with everyone, and we are at our best when we value diverse perspectives, foster open dialogue, and enact change. And we are stronger when each of us is empowered to grow, be our unique selves, and feel a sense of inclusion and belonging.

AccentCare is proud of how we are building a culture and inclusive infrastructure to help elevate the voice of all our employees with a special focus on the underrepresented and marginalized. We offer equal employment opportunities regardless of a person's race, ethnicity, sex, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental disability, physical disability, or any other protected classification.