Position Summary: Responsible for verifying and obtaining authorizations as required upon referral by an insurance plan for home care services. Contacts insurance plan for updates authorization and inform billing department as required. Runs reports daily to monitor and track authorizations. Assists with problem resolution related to the client’s authorization and billing issues. Schedules all nursing and social work visits as required. Collects and collates required information and advises supervisor of issues, as necessary, for timely resolution. Collaborate with other members of the Home Care Team in the selection of the first permanent Home Care Worker who is assigned to ensure that the defined unique needs of the client can be met.

Principal Responsibilities:

• Obtains all initial authorization prior to start of care.
• Runs an authorization expiration certification report weekly and follows-up to get expired authorizations via email, fax or phone, and documents all communication.
• Communicates with insurance plans daily, and/or as necessary, to attempt to obtain re-authorizations/overtime authorizations.
• Maintains records of all written and verbal correspondence regarding status of obtaining authorizations.
• Tracks and monitors all authorizations in a timely manner, informs management weekly of authorizations that are due and ensures authorization is obtained.
• Verifies all authorizations, ensures completeness and accuracy of information and updates computer system with hours, procedure codes and diagnostic codes.
• Schedules all registered nurses and social worker visits in computer system.
• Makes referrals to plans as necessary.
• Responds to all requests from contracts/plans for the nurse supervisory visit report to enhance the authorization process.
• Assists the Contract/Plans in obtaining the M11Q from the clients.
• Forwards all completed M11Qs to the Contract/Plans.
• Creates and maintain a computerized filing system for all authorizations.
• Distributes copies of authorization to the billing department and Case Coordinators.
• Enters all changes of authorized hours into the computer, informing the Case Coordinators of the changes in clients’ hours.
• Collaborates/communicates with the billing department to reconcile authorization gaps or any discrepancies that may be in the authorizations.
• Follow-ups on the Hold Report received from the billing department.
• Maintain a log of all social work authorizations, notifying the Clinical Manager, Intake Liaison, and billing department.
• Initiates call backs and follow-up to patients and providers to coordinate and clarify benefits and services.
• Upon completion of inquiries, initiates call back or correspondence to Physicians/Members to coordinate/clarify case completion.
• Collects and collates information required to handle escalated phone/correspondence inquiries.
• Assist with on-boarding and training of new Team Associate.
• Serve as a backup for Intake Coordinator.
• Coordinate Home Care services to new patients, ensuring that the required level and amount of services are provided timely and safely as prescribed by the patient’s plan of care/authorization.
• Collaborate with other members of the Home Care Team in the selection of the first permanent Home Care Worker who is assigned to ensure that the defined unique needs of the new client can be met.
• Perform other duties as required or assigned.
• Adhere to organization’s standards by completing annual mandatory trainings in a timely manner on topics including – but not limited to – Sexual Harassment Prevention Training, IT Security Awareness, Compliance, OSHA, HIPAA and any other training the organization may deem necessary in regards to regulatory compliance or good business practices.
• Supports organization’s mission by striving for excellence in all aspects of their job with a focus on positive interpersonal relationship with co-workers.
• Adheres to the organization’s policy in regards to absenteeism and appearance and health and safety standards.

Salary Range: $24.00 - $25.71 per hour commensurate with experience.

Job Competencies & Minimum Qualifications:

• Associate’s degree (A.A.) or equivalent of two year’s related experience.
• Computer literate
• Excellent verbal and written skills
• Excellent customer service skills
• Able to multi-task and work independently with a great attention to detail

Working Conditions/Physical Demand:

• Business office environment with phone and computer use.
• Must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds.
• Occasional exposure to toxic or caustic chemicals.