Home Health Auth / Billing Specialist

Description:

Position Summary:

The primary responsibilities include obtaining authorization for Home Care Services, ensuring medical records are accurate, including proper and timely Physician signatures, and ensuring all documents are accounted for and filed. Other responsibilities include, but are not limited to: answering telephones, routing and screening calls, greeting visitors, responding to inquiries from the public, applicants, and providing information about the organization. All employees agree to adhere to the Mission, Vision, and Guiding Principles of Peoples Home Health

Essential Duties & Responsibilities:

• Completes all necessary documentation for initial authorization in accordance with the insurance company contracts.
• Completes all request for all follow up authorization as needed, notifies staff of all authorizations received and visit limits as well as need to discharge client due to denial for further authorization.
• Responsible for maintenance of active and inactive medical records, includes filing and scanning of patient documents, overall file maintenance, and electronic file audits
• Reviews Patient forms and documents to ensure compliance and maintains confidentiality of files at all times
• Reviews Start of Care and Discharge documents for compliance
• Greets all visitors, customers, and staff in a professional and courteous manner. Announces and directs visitors maintaining confidentiality and compliance
• Creates Admit packets and keeps an adequate inventory of packets in stock.
• Prepares and distributes reports; maintains employee communication board (in and out board)
• Schedules employee training and in-services, CPR, annual skills labs, etc
• Prepares and distributes business correspondence, memos, schedules, and other documents
• Oversees front desk and has knowledge of operating a multi-line telephone system, fax, copier, and other types of general office equipment.
• Collects and distributes incoming mail to the appropriate individual/departments
• Promptly distributes incoming faxes to the appropriate personnel, includes lab results, physician orders, referrals, applications, etc.
• Maintains a professional image and an understanding of the companys scope of services
• Understands the company infrastructure and must have ability to transfer calls, resolve issues timely
• Promotes a customer friendly atmosphere for all co-workers and internal/external customers
• Responsible for preparing and submitting clean claims to various insurance companies and self-pay patients either electronically or by paper.
• Field and answer billing questions from patients, clerical staff and insurance companies including but not limited to identifying and resolving billing complaints/issues.
• Maintains and presents weekly billing updates to supervisor.
• Responsible for meeting routine Days Sales Outstanding (DSO) and cash collection goals.
• Must meet payer specific timely billing/filing requirements.
• Performs routine collection duties including but not limited to dunning letters, phone collections and claims corrections, troubleshooting and problem solving.
• Keeps supervisor apprised of billing, collections and delinquent accounts issues.
• Maintains strictest confidentiality of clinical records and billing information in accordance with HIPAA guidelines/regulations.
• Keeps current via literature and training on current rules and regulations of home health agency.
• Types reports, business correspondence, memos, schedules and other documents that may be needed in a timely fashion and with accuracy.
• Performs other duties as assigned

Education/Experience:

• High School Graduate (or equivalent)
• Knowledgeable in general office practices and procedures
• Ability to function with frequent interruptions and handle more than one project at a time
• Proficiency using Microsoft Word, Excel, and PowerPoint is required
• Knowledge of Health Care office functions a plus
• Ability to organize workflow in an efficient manner with accurate results
• Excellent customer service skills

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