Description
Insurance Authorization Specialist- Remote Position
Summary: Oversees all aspects of patient insurance and benefit verification; coordinates clinical information and obtains preauthorization for the assigned acute rehab units. Performs eligibility verification and re-verifications of benefits for Medicare, Medicaid, and commercial insurance payor sources for referrals as needed. Works closely with clinical liaisons, physicians and Program Director to ensure proper insurance information has been obtained in order to facilitate admissions. Maintains a current knowledge of Medicare and State Medicaid requirements and practices. Provides education and training for Clinical Liaisons with third party payors and insurance companies. Completes and compiles insurance reports for re-verification. Coordinates peer to peer reviews when necessary and gathers all relevant data to present cases. Implements standardized process for position to ensure efficiency and accurate communication at all times.
Essential Functions:
Checks eligibility and verifies insurance information for Medicare, Medicaid and commercial carriers.
Utilizes Medicare Common Working File (CWF), to calculate Medicare Days.
Utilizes payor online websites and direct phone contact to check eligibility.
Presents clinical documentation to managed care plans to obtain pre-authorization for ARU admissions; documents and communicates along with requirements for continued authorizations
Advocate for access through coordination of physician peer-to-peer reviews to appeal denials for authorization. Presents medical documentation to support justification for ARU services.
Responds timely with the financials and eligibility to the Program Director.
All financial forms must be legible and completed with all requested information as outlined on the Insurance Verification forms.
Performs data analysis which is often confidential in nature, to include the use of Excel and SharePoint
Maintains a current knowledge of modification to Medicare and state Medicaid plans as they impact Post Acute Care.
Provides quarterly education to the Program Director on insurance changes and trends. Provides support and answers questions regarding anything related to insurance.
Provides Ad-hoc tasks as requested by Program Director.
Performs other duties as requested and required.
Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
Reports out daily on activity and weekly based on goals/ objectives measurements set.
Knowledge/Skills/Abilities:
Ability to gather data, compile information, and prepare reports
Advanced data entry and/or word processing skills
Strong knowledge of Word, Excel, and Outlook functions.
Strong typing and computer skills
Background and/training in medical terminology
Ability to verify data input and correct errors
Ability to interact and communicate with people over the phone, often in stressful situations.
Ability to work independently.
Ability to communicate effectively, both orally and in writing.
Excellent customer service abilities to represent both partner hospitals and Kindred
Able to maintain confidentiality of all resident information to assure resident rights are protected.
Qualifications
Bachelor Degree Preferred
Licenses/Certification: LPN preferred
Experience:
2-5 years Post-acute healthcare experience in Billing and/or Insurance Verification. At least one year using Database Administration, Common Working File and other verification systems.
Equal Opportunity Employer/Veterans/Individuals with Disabilities. Drug Free Workplace