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Authorization Specialist

Company: Capital Health Home Care - Dublin
Location: Dublin
Posted on: May 28, 2023

Job Description:

We offer a comprehensive Benefit package to Full Time Employees:

  • PTO
  • 401-k with Company match
  • Health Insurances
  • Company Paid Life Insurance
  • Tuition Reimbursement
  • Employee Assistance Program

    Job Description Summary

    The Authorization Specialist works with multiplepayor sources and obtains insurance authorization for physician orderedservices. The position is responsible for monitoring and recertifying patientinsurance authorization prior to the current expiration date.

    Essential Job Functions/Responsibilities

    1. Coordinateshome care services for managed care and private insurance patients throughverification of home care benefits on an ongoing basis.
    2. May assist agency intake departments tofacilitate patient admission to home care by verifying benefits and obtaining initialauthorizations.

    3. Works with agency staff to gather and reportpatient care information to managed care/private insurance case managers.

    4. Maintains comprehensive working knowledge ofmanaged care/private insurance home care benefits and shares information withappropriate agency personnel.

    5. May assist members of the billing team toensure that managed care/private insurance customers are billed according toagreements.

    6. Responsible for accurate entry of patientinsurance information and approved authorizations into designated softwaresystem.

    7. Completes the authorization process within established time frames.

    8. Works closely with andsupports team efforts to accomplish authorizations.

    9. Promptly responds to managed care/privateinsurance customer's requests.

    10. Requests authorization from insurance companycase manager to provide specific services and parameters of care.

    11. Assists in building community, customer, payorand patient perceptions of the agency as a high-quality provider of services.

    11. Establishes and maintains positiveworking relationships with agency staff and potential customers.

    12. Provides effectivecommunication to patient/family, team members, and other health careprofessionals and maintains confidentiality.

    13. Assist billing withclaim issues due to insurance authorization denials.

    14. Maintains and reviewstracking reports on outstanding authorization to ensure timely request,receipt, and processing of authorizations.

    15. Work closely with theclinical teams regarding current and future authorization needs.

    16. Performs other duties asassigned.
    The above statements are intended to be arepresentative summary of the major duties and responsibilities performed by incumbentsof this job. The incumbents may be requested to perform job-related tasks otherthan those stated in this description.

    Position Qualifications

    1. High School diploma or equivalencyrequired.

    2. One (1) or more years of insuranceauthorization experience preferred.

    3. Prior experience in home health orhospice preferred.

    4. Ability to deal tactfully withstaff, customers and the community.

    5. Demonstrates good communication.

    6. Demonstrates autonomy, organization,flexibility, and cooperation in performing job responsibilities.

    At Capital Health Care Network, our company culture is built on the following seven essential skills of teamwork:
    • Active Listening: Team members listen to each other's ideas.They are observed validating ideas through active listening and "piggy-backing" (or building) off each other's ideas
    • Communication: Team members communicate.They are observed interacting, discussing, and posing questions in an effort to fortify understanding and dispel miscommunication
    • Persuading: Team members use persuasion. They are observed exchanging, defending, and rethinking ideas with the greater good in mind
    • Respecting: Team members respect the opinions of others.They are observed encouraging and supporting others' ideas and efforts
    • Helping: Team members help.They are observed offering assistance to each other
    • Sharing: Team members share.They are observed sharing ideas, information and influence
    • Participating: Team members participate.They are observed participating in social media, campaigns, and projects

Keywords: Capital Health Home Care - Dublin, Columbus , Authorization Specialist, Other , Dublin, Ohio

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