[Hiring] Authorization Specialist Lead I @Hartford HealthCare at Home

Role Description

The Home Health and Hospice Authorization Specialist Lead 2 entails supporting the Prebilling and Authorization Manager in training, payor updates, and identifying metrics around eligibility and authorizations. Responsibilities include:

• Ensuring accurate and timely processing of patient insurance verifications and prior authorization requests.
• Reviewing submitted information and resolving complex cases.
• Maintaining quality standards within established payor guidelines.
• Verifying insurance eligibility and authorization requirements for Home Health and Hospice clients.
• Communicating payor eligibility and authorization information to necessary parties.
• Working independently as well as within a team environment.
• Assisting in identifying Quality Assurance Reviews (QARs) and inaccuracies within accounts.
• Performing other related duties as assigned by the Prebilling and Authorizations Manager.

Qualifications

• Education: High School Diploma required.
• Experience: One year of experience within a healthcare setting and familiarity with payor sources and processes required; two to four years preferred.
• Language Skills: Strong written and verbal English communication skills are necessary.
• Knowledge of third party payor regulations including Medicare, Assistance, Veterans Affairs (VA), and private insurance.
• Ability to promote and maintain a positive attitude.
• Strong organizational skills and the ability to work independently with minimal supervision.
• Basic computer skills with the ability to learn new software; knowledge of Word and Excel a plus.

Requirements

• Communicates payor authorization and eligibility information to Clinical Manager, Business Manager, or designee.
• Enters insurance authorization and eligibility information according to payor specific guidelines.
• Notifies branches regarding lack of payor coverage or other service non-coverage issues.
• Performs re-authorization and eligibility checks in a timely manner.
• Monitors and ensures all client authorization of services are current and meet payor requirements.
• Maintains professional, positive, and effective communication with payors, clients, Corporate, and branch employees.
• Participates in the after hours on-call process to assure client care policies and procedures are followed.
• Establishes performance expectations of staff, coaches, develops, and mentors by evaluating performance.
• Keeps Revenue Cycle resources and other key leaders apprised of problems/concerns/delays within the authorization department.
• Stays up to date with industry trends and best practices in billing requirements.
• Leads or serves on recurring workgroups and special projects.

Benefits

• Competitive benefits program designed to ensure work/life balance.
• Opportunities for career development and growth.
• Part of an organization on the cutting edge of healthcare technology and community education.