[Hiring] Intake and Precertification Specialist @WVU Medicine

Role Description

The Intake and Precertification Specialist – Home Health and Hospice is responsible for managing intake, insurance authorization and administrative coordination of patient referrals for Home Health and Hospice Services. This role ensures timely and accurate prior authorizations, maintains documents, monitors certification deadlines, supports denial management and facilitates communication between patients, providers, and internal teams to ensure efficient service delivery and compliance with payer requirements.

Qualifications

• High School Diploma or equivalent.
• Two (2) years’ experience in insurance verification, authorization or healthcare intake.

Requirements

• Coordinate the intake process for new patient referrals, including receiving referral information from healthcare providers, performing insurance verification and scheduling initial assessments.
• Serve as the primary point of contact for patients, families, referral sources and healthcare professionals regarding referral and authorization status.
• Obtain and document initial and ongoing authorization numbers using EPIC or other electronic systems.
• Maintain accurate documentation of precertification, authorization activity and referral communications.
• Communicate with insurance companies to obtain prior authorization for services and resolve authorization related issues.
• Monitor authorization status to ensure no certifications or recertifications are missed ensuring proper sequencing of payors for billing purposes.
• Enter and maintain patient referral and insurance information in appropriate systems.
• Coordinate scheduling of initial assessments with clinical staff as needed.
• Maintain current knowledge of CPT coding and HCPC’s in order to be able to precertify/authorize home health/hospice referrals.
• Assist with denial management, audits, and documentation requests as needed.
• Track referral activity and ensure timely processing to support admission and billing.
• Communicate with internal departments regarding authorization status and referral progress.
• Demonstrate ability to maintain established productivity and throughput expectations in a high-volume referral environment.
• Ability to manage multiple priorities simultaneously while maintaining accuracy, efficiency and timeliness.
• Consistently meet required turnaround times and deadlines related to referral processing, authorization and documentation.
• Provide exceptional customer service to patients, families and referral sources and care teams, ensuring seamless and positive experiences.
• Demonstrate strong attention to detail while working in a fast-paced, deadline-driven environment.

Company Description