Prior Authorization Specialist

Job Description

JOB DETAILS

REQUIREMENTS

• At least 1 year of insurance authorization/billing experience in a medical office, preferably home health/hospice. Must have this experience if remote.
• Experience with Home Care Home Base is strongly preferred
• Demonstrated cooperation and excellent customer service skills
• Ability to multi-task and stay on task in a fast-paced office
• Excellent team-oriented, verbal, and written communication skills

RESPONSIBILITIES

• Verify insurance coverage, including primary and secondary payors
• Use UGS/DDE and EDS programs to verify Medicare/Medicaid eligibility
• Obtain visit authorization via payor by providing appropriate medical records
• Perform accurate data entry in patient records within HCHB
• Maintain payor files with up-to-date requirements to obtain/initiate appeals for denied authorizations
• Interface with contract, clinical, and office staff to foster collaboration and positive working relationships
• Prepare patient co-pay estimates and notify scheduling of authorized visits
• Provide excellent customer service to patients, referral sources, and community contacts with questions regarding payor prior authorizations and medical guidelines
• Enter, audit, and follow up on authorized and unauthorized visits within HCHB

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