Company:

Compassus

 

Position Summary

The Insurance Specialist is responsible for modeling the Compassus values of Compassion, Integrity, Excellence, Teamwork, and Innovation and for promoting the Compassus philosophy, using the 6 Pillars of Success as the foundation. S/he is responsible for upholding the Code of Ethical Conduct and for promoting positive working relationships within the company, among all departments, and all external stakeholders. The Insurance Specialist is primarily responsible for obtaining and tracking insurance verification and authorization/re-authorization for home health care services for new or existing patients in accordance with their third-party payor policies while following all federal, state, and local regulations including Medicare and Medicaid guidelines.

Position Specific Responsibilities

Completes insurance verification on all new and existing patients and follow-up appropriately for authorization.Contacts insurance carriers to obtain benefit coverage for ordered services, policy limitations, authorization/notification, and pre-certifications for patients.Follows up with physician offices, customers, and third-party payers to complete the pre-certification process.Requests authorization from insurance company case manager to provide specific services and parameters of care.Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third-party payer requirements/on-line eligibility systems.Reviews the insurance verification and completes the authorization process within established time frames.Enters data into software program accurately.Maintains a thorough understanding of the revenue cycle which includes insurance requirements, billing, and associated correspondence and can independently resolve issues.Scans and uploads appropriate documents to the patient chart and assists with completing patient profile.Works closely with and supports team efforts to accomplish authorization/verification.Participates in reimbursement, certification and authorization related activities as directed.Documents payer and authorization information with the EMR system.Completes Payor Change process, as needed.Provides effective communication to team members, and other health care professionals and maintains confidentiality.Attends all company training, when offered. Reports information systems security problems.Maintain payor portals, notification of payor changes, etc.Performs other duties as assigned.

Education and/or Experience

High school diploma or GED required.One (1) or more years of insurance authorization experience preferred.Prior experience in the home health care billing industry preferred.Utilization management experience and pre-certification helpful.Customer service experience desired.

Skills

Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percentage.Language Skills: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from leaders, team members, investors, and external parties. Strong written and verbal communications.Other Skills and Abilities: Ability to understand, read, write, and speak English. Articulates and embraces integrated healthcare at home philosophy. Knowledge of insurance policies for home care authorizations. Ability to establish and maintain effective working relationships with all segments of the branch staff, billing, and collections department and, insurance representatives. Self-Starter and able to work independently. Ability to multi-task. Usage of Medical Terminology. Strong negotiation and conflict management skills. Computer literate and can learn new software programs. Can use basic office equipment.

Physical Demands and Work Environment: The demands of this role necessitate a team member to effectively perform essential functions. Adaptations can be made to accommodate team members with disabilities. Regular standing, walking, and manual dexterity are fundamental, along with the ability to lift and move objects up to 25 pounds. Visual acuity requirements include close and distance vision, color and peripheral vision, depth perception, and the ability to adjust focus. This description provides a general overview and may vary by role and department, capturing the nuanced demands and conditions inherent to positions in our organization.

At Compassus, including all Compassus affiliates, diversity, equity, and inclusion are fundamental to our Pillars of Success. We are committed to creating a fair work environment where our team members feel welcomed, highly valued, and respected. As an equal opportunity employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

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