Insurance Authorization Specialist

Administrative McKinney, Texas McKinney, Texas Full Time


Description

AccentCare is looking for passionate clinicians committed to delivering exceptional care in the home.

We are committed to quality patient outcomes—delivering evidence-based care in the home—and providing comprehensive training to further develop our staff along with continuing education and promotional opportunities.

Come join the AccentCare team and Make A Difference every day.

Position: Insurance Authorization Specialist 

Location: McKinney, TX

Shift: Full Time

 

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.
  • 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.
  • 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:

  • 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 of Federal, State, and accreditation regulations governing home care
  • Proficiency with MS Office Word, Excel and Outlook
  • 1+ year previous experience with insurance verification / authorization or Billing experience