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.