Insurance Mgmt Specialist, Per-Diem, Days 8am-4pm, and Weekendss, Morristown

Job description

Duties & Responsibilities: Communication - Function as a liaison between external Insurance Companies and internal staff to ensure patient needs are met. - Notify internal staff when patient updates are required. - Communicates with CAC & Clinical Teams to ensure required financial information is available to review with patient. - Communicate with Clinical Teams to request necessary information for ongoing authorizations in a timely manner. Insurance Verification - Verifies patient insurance for all incoming referrals for all payers. - Verifies patient insurance during course of episode if payer change occurs or a need for re-verification arises. - Participates in the re-verification at designated times of year, i.e. open enrollment period. - Documents all verification information in EPIC to ensure CAC, clinical teams and other departments are aware of results. Authorization - Obtain timely initial precertification and authorization for initial services when required. - Understands and enters pending authorization as required. - Demonstrated knowledge of payors and required documentation for precertification and authorization. - Obtains timely authorization for ongoing authorizations for home care and hospice services from select payers online, by telephone or fax per company requirements. - Documents all authorization information in Epic to ensure clinical communication, as well as accurate system notification of ongoing needed authorization. - Reviews additional service request for completeness of information, accuracy and presence of required clinical data. - Request and /or submit clinical documentation for authorization/reauthorization in Epic, prepares updates as indicated. Department Workflow - Ensures coverage of department for assigned hours of operations. - Manages assigned patient, insurance and/or acct EPIC work queues, ensuring accurate and timely completion. - Supports data integrity by running or working reports to identify and correct areas of inaccuracy. - Participates as needed in the follow-up and correction of insurance and/or authorization information, including the process required for payer changes, or obtaining retro authorization. - Participates as directed by Supervisor of Verification/Authorization in the EVV process. Other Duties - Performs other duties as assigned.