Authorizations and Orders Specialist

Excell Home Care & Hospice

Excell's legacy of excellence is to provide life-changing services to our Oklahomans. We are celebrating 30! You can be part of a historic legacy that lives into the future! Be an advocate for quality of care, you and your 'why' change the lives of our patients, families, and healthcare partnerships in our Oklahoma City community. Come be a beacon, and build into our legacy your passion, your reason for life-changing care. We know why we do this noble work, and just like you, together we make our reason the one to call Excell Home Care & Hospice, Home.

Job Summary

Responsible for coordinating home care services for managed care patients, which includes establishing and maintaining the patient's plan of care, establishing and maintaining positive relationships with managed care customers and related referral sources.

Duties & Responsibilities

• Verifies insurance coverage and obtains initial authorizations for services and seeks reauthorization for ongoing and additional services.
• Works with Director or Nursing and staff clinicians to gather, collate, and report patient care summary information to managed care Case Managers with other insurances.
• Maintains comprehensive working knowledge of managed care contractual relationships and ensures that patients are admitted, and services are delivered in accordance with contract provisions.
• Works with members of the billing team to ensure that managed care customers are billed according to Case Manager Agreements.
• Establishes and maintains positive working relationships with current and potential managed care customers.
• Promptly responds to managed care customer's requests and concerns.
• Assists in building community, customer, and payer and patient perceptions of Excell Home Care & Hospice as a high-quality provider of services.
• Maintains comprehensive working knowledge in the field of managed care and shares information with appropriate organization personnel.
• Performs/oversees: Order/F2F Tracking-monitors all aspects of Plan of Treatment/order tracking, to include checking in orders/Plan of Treatment on a daily basis, verifying all incoming orders are signed and dated by physician and/or Excell staff as appropriate. Accurately encodes physician orders, Medicare certification/recertification.
• Performs/oversees open orders report for timely approval. Regenerates late orders for signature (Supplemental 14 days, Certification 21 days). Works with physician liaisons as appropriate.
• Manages clinical records functions including establishing and implementing clinical records policies.
• Ensures clinical record systems are maintained in compliance with state, federal and regulations.
• Protects all clinical records through the establishment and implementation of control procedures for all open and closed records.
• Protects the confidentiality of patient and organization information through effective controls and direct supervision of clinical records.
• Forwards copies of clinical records to authorized users according to policy.
• Monitors aged unsigned physician orders and submits second and third requests for signed orders to overdue physicians, calls or visit the offices of seriously overdue physicians.
• Supervises the use of the clinical records information system and maintains a comprehensive working knowledge of the system including upgrades and enhancements.

Job Requirements (Education, Experience, Knowledge, Skills & Abilities)

1. At least one year of experience in health care managed care coordination, preferably in home health care or an internship of comparison, preferred. 2. Complies with acceptable professional standards and practice. 3. Knowledge of corporate business management and managed care environment. 4. Demonstrates good communication and public relations skills. 5. Demonstrates autonomy, organization, assertiveness, flexibility, and cooperation in performing job responsibilities. 6. Knowledge Word, Excell, Adobe PDF. 7. Demonstrate ease of working with multiple EMR platforms.

Based in Oklahoma City and operating in various counties throughout the state, Excell Home Care and Hospice is Medicare certified and licensed by the Oklahoma State Department of Health.

Excell Home Care and Hospice is an Equal Opportunity Employer. We evaluate qualified applicants without regard to race, color, religion, sex, national origin, disability, veteran status, and other protected characteristics.

Excell is compliant with CDC guidelines, CMS state and federal law pertaining to patient care, the EEOC, and all other applicable state and federal laws, including COVID-19 pandemic and vaccination mandates. EXCELL follows EEOC guidance on medical and religious exemptions and welcomes all applicants regardless of their COVID-19 vaccination status.