Authorization Specialist

JOB PURPOSE:

Reporting to the Area Vice President, AVP, or the Regional Business Office Manager, RBOM, an Authorization Specialist ensures patients receive timely and authorized healthcare services. The position involves a blend of administrative tasks, customer service, and knowledge of insurance coordination of benefits.

KEY RESPONSIBILITIES:

1.Verifies insurance coverage and documents benefit maximums for all home health services in the medical record.

2.Secures prior authorization from insurance companies and documents approval details appropriately in the EHR system.

3.Collaborates daily with branch staff, insurance companies, and patients as needed to ensure a smooth authorization process.

4.Addresses issues related to denials, discrepancies, and incomplete information in a timely manner.

5.Remains abreast of changes in insurance, prior authorization requirements, and policies with contracted insurance companies.

Qualifications:

MINIMUM EDUCATION REQUIRED:

High School Diploma or equivalent.

MINIMUM EXPERIENCE REQUIRED:

Applicants should possess a minimum of two years prior experience in obtaining medical authorizations.

KNOWLEDGE, SKILLS, ABILITIES:

• Must have proficient working knowledge of a computer and all Microsoft Office products.

• Successful candidates possess strong communication, organizational and time management skills to function effectively in a fast-paced environment with multiple priorities.

• Knowledge and understanding of Medicare, Medicaid, Private Pay and Third Party reimbursement.

Disclaimer**

The above information is intended to describe the general nature and level of work being performed by people assigned to

this job. It is not intended to be an exhaustive list of responsibilities, duties and skills required of personnel so classified.

Please provide all new hires with a copy of this job description and maintain a signed copy in the partners Personnel File.

• Reports as directed when called in during a disaster or other emergency situation as directed by agency operations.

• Demonstrates knowledge of confidentiality and HIPAA rules/regulations, corporate compliance as well as applicable department policies and procedures and standard operation procedures (SOPs) related to confidentiality.

• Provides administrative support to clinical and agency operations staff as needed.

• Participation as directed in agency survey for accreditation or licensure and any subsequently required reports.

• Comply with corporate compliance program.

• Attends and participates in continuing education programs to keep abreast of changes in the field.

• Attends mandatory in-services and meetings as assigned.

• Reports any job-related functions/tasks that involve occupational hazards including exposure to blood and body fluids and others as necessary.

• Follows established safety regulations, to include fire protection and prevention, smoking regulations, infection control, etc.

• Perform other related duties as necessary and as directed by supervisor.

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