Authorization Specialist

Job Description Summary

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

Essential Job Functions/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.

Submit CHAPS reporting for both Home Health and Hospice (critical)

Provides HCHB support, guidance and consistent training in conjunction with the Director of Nursing and Director of Operations.

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 Title/Position: Authorization Specialist

Position Qualifications

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.

Physical Requirements & Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

May be required to alternately sit, stand, walk, stoop, or bend. Work is performed primarily indoors, sitting. Noise level is moderate.

ACKNOWLEDGEMENT

I, the undersigned, understand that my employment is "at will" and accept the position of Authorization Specialist.  I also accept the requirements and responsibilities listed in the above job description and agree to be accountable for these responsibilities.