Insurance Authorization Specialist RN

Administrative McKinney, Texas Full Time


Description

AccentCare, Inc.® is a national post-acute healthcare provider with over 45 years of industry experience. We thrive on providing patient-centric care and a warm and personalized experience within our local communities. 

Your Success is our Success. We strive to provide our new employees with a structured on-boarding process to help you become assimilated quickly, and cutting-edge tools to make your daily work easier and more efficient. We offer extensive training and a wide-array of opportunities for continued education and promotional opportunities.

Position:                                Insurance Authorization Specialist – RN Reviewer   

Reports to:               National Director of Insurance

Job Description/Requirements:                                                                                                                                     

As an Insurance Authorization Specialist, you will:

  • Be responsible for oversight of the insurance authorization process regarding case management of care clusters and patient pathways. To include timely and complete processing of eligibility and benefit verification, initial and ongoing authorization requests following set guidelines and accurate entry of related information in designated software system.
  • Perform routine audits and process improvement recommendations to leadership.
  • Provide reporting assistance as required or requested by leadership.
  • Review and build Communication Bridge with branch in regard to adherence of visit parameters and assistance or explanation of exceptions.
  • Maintain policies and procedures to ensure timely communication of verification and authorization status to field locations, providing necessary information to facilitate decision making for patient care clusters, pathways and visit utilization coverage. Communicates with management on areas of risk. Provide tracking and regular updates on outstanding issues when required.
  • Maintain efficient tracking of all pending authorizations for team to ensure timely resolution and avoid loss of revenue.
  • Create and assist in creation of best practices for payor management teams.
  • Create job aids and standard operation procedures to follow the company initiatives for training at local and operations level.
  • Perform routine review of outstanding requests and redirects workload as appropriate.
  • Coordinate communication with the contracting department on payer related issues as appropriate.
  • Ensure effective communication among team members; operations, finance, clinical, and support staff.
  • Demonstrate ability to solve problems independently and perform at optimal level.
  • Maintain confidentiality and privacy of patient/family finances, records, health status, etc.

Requirements of Qualified Candidates:

  • RN with applicable state license
  • High School Diploma Required
  • Able to work any shift between 7 am and 7 pm and occasional Saturdays & Sundays
  • Working knowledge of billing activities, Medicare and Non-Medicare Home Health payer requirements
  • Knowledge and prior experience for clinical documentation review
  • Preferable experience with payor case management and interaction
  • Knowledge of Federal, State, and accreditation regulations governing home care
  • Proficiency with MS Office Word, Excel and Outlook
  • 3+ year previous experience with insurance verification / authorization and Billing experience


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