The Authorization Specialist accurately and effectively coordinates staffing and patient scheduling duties for the agency as well as interacts with the billing department by obtaining insurance authorizations, and verifying eligibility and benefits as needed.
Position Duties and Responsibilities: Component Proportion 80%
- Accurately enters patient episode schedules and changes/updates into data base and notifies appropriate staff to these changes/updates. Verifies early/late episodes as well as re-verifies the Insurance policy number for the patient prior to case conference.
- Arranges for staffing of new referrals utilizing appropriate clinical staff based on discipline and geographical area. Assist with verifying patient benefits and inputs into the database as back up.
- Effectively provides administrative management of commercial insurance patients (benefit verification, reauthorization, scheduling).
- Tracks patient status, with assistance from the Marketing team, until patient is admitted.
- Other duties as assigned.
Reporting/Planning: Component Proportion 20%
- Provides reports/census and updated status at case conference.
- Reviews the staff weekly schedules for appropriateness and notifies the ADON of any scheduling issues/concerns.
- Distributes weekly schedule to staff members every Friday as needed.
- Attends weekly case conferences and follows up with scheduling issues/concerns.
- Promotes effective, positive and respectful communication to patients, staff members, other healthcare professionals and referral sources.
- Promotes agency vision and administrative policies by maintaining a high level of ethical standards.
- Presents a professional image of self and agency as outlined in the employee handbook.
- Other duties/projects as assigned.
Education, Previous Work Experience, Skills/Abilities and General Requirements for position
- Must have a high school education or equivalent.
- Working knowledge of Medicare/Medicaid home health care benefits, rules and regulations.
- Minimum of one year general office experience.
· Some knowledge of medical terminology preferred.
· Have excellent knowledge of computers.
· Have the ability to motivate others in a positive manner.
· Have good verbal and written communication skills.
· Possess well developed interpersonal skills.
· Have the ability to organize work and schedule effectively.
· Have the ability to think analytically.
- Must have satisfactory references from previous employers.
- Must be able to pass a criminal history check.
- Must be able to pass a random drug test.
- Must have a dependable vehicle and a valid driver’s license.