Insurance Mgmt Specialist, Per-Diem, Days 8am-4pm, and Weekendss, Morristown

Duties & Responsibilities: 

Communication 

• Function as a liaison between external Insurance Companies and internal staff to ensure patient needs are met.


• Notify internal staff when patient updates are required.


• Communicates with CAC & Clinical Teams to ensure required financial information is available to review with patient.


• Communicate with Clinical Teams to request necessary information for ongoing authorizations in a timely manner.

Insurance Verification

• Verifies patient insurance for all incoming referrals for all payers.


• Verifies patient insurance during course of episode if payer change occurs or a need for re-verification arises.


• Participates in the re-verification at designated times of year, i.e. open enrollment period.


• Documents all verification information in EPIC to ensure CAC, clinical teams and other departments are aware of results.

Authorization

• Obtain timely initial precertification and authorization for initial services when required.


• Understands and enters pending authorization as required.


• Demonstrated knowledge of payors and required documentation for precertification and authorization.


• Obtains timely authorization for ongoing authorizations for home care and hospice services from select payers online, by telephone or fax per company requirements.


• Documents all authorization information in Epic to ensure clinical communication, as well as accurate system notification of ongoing needed authorization.


• Reviews additional service request for completeness of information, accuracy and presence of required clinical data.


• Request and /or submit clinical documentation for authorization/reauthorization in Epic, prepares updates as indicated.

Department Workflow

• Ensures coverage of department for assigned hours of operations.


• Manages assigned patient, insurance and/or acct EPIC work queues, ensuring accurate and timely completion.


• Supports data integrity by running or working reports to identify and correct areas of inaccuracy.


• Participates as needed in the follow-up and correction of insurance and/or authorization information, including the process required for payer changes, or obtaining retro authorization.


• Participates as directed by Supervisor of Verification/Authorization in the EVV process.

Other Duties

• Performs other duties as assigned.

Required: 

1. High School Diploma

Preferred: 

• Prefer Associates or Bachelors degree in related field 
• Training or experience in health care field, familiar with health care terminology.
• Training or experience with basic secretarial functions/equipment (PC, fax, telephone) 
• Effective verbal and written communication skills.   
• Broad knowledge of computer software including word processing, spreadsheets and presentation applications; keyboarding skill level at 45wpm. 
• Preferred for positions in medical/clinical areas: basic medical and scientific terminology.  
• Bilingual preferred. 

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