[Hiring] Home Health Authorization Specialist @Trinity Health

Role Description

The Authorization Specialist is responsible and accountable for the processing of all THAH authorization documentation meeting HCFA/MCC/JCAHO regulations and guidelines. Primary responsibilities include:

• Processing all frontend documentation needed to meet third party payer authorization deadlines assuring accurate billing.
• Monitoring all accounts for ongoing authorization needs to ensure optimal reimbursement and compliance per agency policy.
• Working closely with the THAH insurance team and THAH Collection analysts in tracking authorizations and resolving problematic billing issues.
• Monitoring pending authorizations report and collaborating with both the clinical and revenue cycle team to review and resolve pending claims to ensure timely payment.
• Duties may be accomplished in a remote work environment.

What You Will Do:

• Prepares and enters data into the appropriate software assuring the accuracy of the regulated client account following all regulations placed on the homecare agency.
• Ensures that input of information is accurate, and authorization is received timely for the submission of claims.
• Responds to all system issues by preparing documentation for the resolution center.
• Timely follow up on pending authorizations to ensure payment of claims.
• Generates all authorization documentation needed to bill in a timely manner assuring industry standards are met.
• Monitors and processes the Subsequent Authorizations workflow and reports daily to assure timely and clean billing.
• Utilizing the CQI Process Improvement technique, responsible for implementing and monitoring changes to processes to ensure continued integrity of client accounts.
• Collaborates with the Intake Department to identify processes for improvement ensuring the accuracy of the authorization process.
• Provides statistical feedback regarding the status of unbilled claims due to authorizations to THAH Revenue team on a weekly basis or as defined by policy.
• Interfaces with THAH to resolve problems related to the processing of bills/claims.
• Investigates client accounts and provides any additional documentation required.
• Seeks assistance of Clinical Team Leaders and/or Revenue Cycle Leaders with clinical data entry and/or billing problems.
• Coordinates the flow of billing related paperwork between the branch and THAH Service Center.
• Works with the branch and THAH colleagues to identify areas of improvement related to authorization workflow.
• Actively participates in all billing conference calls between the agency and THAH.
• Acts independently and responsibly to perform duties on a consistent basis and in a timely manner.
• Coordinates tracking system to monitor unbilled claims due to authorizations and utilizes appropriate monitoring reports available.
• Acts as liaison between physician offices, THAH Service Center and the agency to assure timely billing with appropriate documentation.
• Ensures that services provided support continuous quality improvement, customer-oriented focus, and quality client care outcomes.
• The duties and responsibilities described are not a comprehensive list and additional tasks may be assigned from time to time, as the scope of the job may change as necessitated by business demands.

Qualifications

• The incumbent can articulate and demonstrate a commitment to the mission, vision, and values of Trinity Health and to inspire active support of these in others.
• The preferred candidate will have a high school diploma or GED.
• College business courses or an associate degree is preferred, or four to six years of experience in a medical billing office setting with a concentration on authorizations.
• A strong knowledge of general business office functions, strong analytical and organizational skills and microcomputer usage is required.
• Incumbent must possess the following: ability to meet strict deadlines with high level of accuracy, ability to prioritize multiple tasks in highly automated setting and possess strong interpersonal skills.
• Ability to consistently demonstrate commitment to the mission and Organizational Code of Ethics and adhere to the Compliance.

Benefits

• Day 1 Benefits - Health, dental and vision insurance
• Work Today Get Paid Tomorrow
• Employee Referral Reward Program
• Short and long-term disability
• Tuition Reimbursement
• Paid CEUs
• 403b
• Generous paid time off
• Comprehensive orientation