Authorization Specialist

JOB SUMMARY

The Authorization Specialist obtains insurance verification on patient admissions and recertification’s and works with Billing and Patient Care Staff to resolve issues.

DUTIES & RESPONSIBILITIES

Contact insurance company/case managers to verify patient insurance coverage and obtain information concerning the extent of benefits.

Utilize the UGS/DDE and EDS computer programs to verify eligibility for Medicare and Medicaid, and thoroughly research any possible secondary payers.

Prepare insurance verification form with data such as names of insurance company and policyholder and policy number.  Accurately enters insurance information into Homecare Homebase (HCHB).

Prepare estimates of patient copayment for clinician to deliver to patient and notifies clinician of preauthorized visits.

Enters visit authorizations into HCHB computer system and maintains an audit system for additional visit authorization needs.  Reports unauthorized visits to supervisor when applicable. 

Maintains audit system for tracking True Blue authorizations for recertification.

Maintains audit system for tracking hospice recertification’s.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job.  The incumbents may be requested to perform job-related tasks other than those stated in this description.

JOB REQUIREMENTS (Education, Experience, Knowledge, Skills & Abilities)

Strong written and oral communication skills in person and over the phone.

Excellent customer service skills

Strong team skills

Organized

Flexible—responds well to changing priorities and conditions.

Technical aptitude to know or learn and master the agency’s clinical software.

WORKING ENVIRONMENT

Blood & Bodily Fluids

Latex

Other:

Disease

Hazardous Drugs

Other:

TB

Odors, Chemicals

Other:

PHYSICAL REQUIREMENTS

Please complete based on a normal day’s work. Employees are asked to sign a statement indicating whether they can perform the essential functions of their position. Requests for accommodation will be considered on an individual basis.

This Job

10 lbs

25 lbs

10 lbs

50 lbs

25 lbs

10 lbs

100 lbs

50 lbs

20 lbs

Very Heavy

> 100 lbs

> 50% of day

20% -50%of day

Up to 20% of day

Twisting/turning from waist

Left/right foot movement

Push/Pull objects

Reaching above shoulder level

Reaching below shoulder level

Handing (holding, grasping, working with hands)

Repetitive movement of the hand (includes typing and ten-key use)

Check if Appropriate

Senses needed to perform essential functions of the position: Hearing, talking, depth perception, color, vision, touch and smell.

Maintain a stable posture and gait with hands free to perform anticipated or routine and emergent patient care.

Endurance (cardiovascular fitness)

Physically and mentally able to work extended hours when necessary

ACKNOWLEDGEMENT

I have read this job description and fully understand the requirements and notices set forth therein.  I hereby accept the position and agree to perform the identified essential functions in a safe manner and in accordance with the Company’s established policies and procedures.  I agree to request guidance from my supervisor in the event that I am unsure of how to interpret any policy.

I further understand that my employment is at-will and thereby understand that my employment may be terminated at-will either by the Company or myself, and that such termination can be made with or without notice.

This position consistently supports and promotes compliance with the Code of Conduct by maintaining the privacy and confidentiality of information, protecting the assets of the agency, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal, State, and local laws and regulations, accreditation and licensure requirements (if applicable), and all policies and procedures.