Home Health Insurance Authorization Specialist

at Centerwell in Boise, Idaho, United States

Become a part of our caring community

This is a full time remote position scheduled 40 hours, 5 days a week for 8 hour shifts.

The schedule you will work is Monday-Friday from 9:30am-6pm EST .

As a Home Healthcare Insurance Authorization Specialist , you will report directly to the Authorization Supervisor. You will:

+ Daily audit of admission, discharge and other source documentation to ensure revenue is recognized appropriately and all conditions of payment are met.

+ Verify patient eligibility and payor coverage guidelines to ensure that all necessary information is secured for accurate revenue recognition.

+ Weekly generation of site revenue and resolution of batch errors and bill holds.

+ Weekly communication with site leadership detailing outstanding documentation or other issues resulting in a potential loss of revenue.

+ Prepare and submit invoices to Accounts Payable for reimbursement and perform follow up to ensure accurate payments are made to our facility partners.

+ Prepare, submit, and follow up on authorization and re-authorization requests according to applicable state and commercial payor guidelines.

+ Coordinate, review, and analyze documentation and data entry supporting Medicare, Medicaid, and commercial payer requirements to ensure accurate and timely billing.

+ Ensure all internal controls and related policies/procedures are implemented and followed in accordance to the accounts receivable requirements.

+ Ensure all payer requirements are met, including pre-cert requirements, notification requirements, and level of care change required documents.

+ Alerts appropriate team members at the Site regarding late or missing documents required for billing.

+ Establish and maintain positive working relationships with Sites, Nursing Home Facilities, and AR Teams.

+ Maintain the confidentiality of patient/client and agency information.

+ Maintain accurate and up to date information for all vendor and nursing facility contracts.

+ Keep information in an orderly manner accessible for review. Present status as requested.

+ Assure compliance with local, state and federal laws, Medicare regulations, and established company policies and procedures.

+ Participate in special projects and perform other responsibilities as assigned.

+ Help train newly-hired associates, as well as re-education of revenue teams.

+ Information resource for any hard revenue generation issues or system issues. Basically the subject matter e