Insurance Specialist - 10a to 7p

Position Summary The Insurance Specialist is responsible for modeling the 3 Company values of Compassion, Integrity, and Excellence, 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. This role will work a 10am to 7pm shift. 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, colleagues, investors, and external parties. Strong written and verbal communications. Other Skills and Abilities: Ability to understand, read, write, and speak English. Articulates and embraces hospice 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 physical demands described here are representative of those that must be met by a colleague to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the colleague is regularly required to use hands to finger, handle, or feel; talk and hear. The colleague frequently is required to stand, sit, and reach with hands and arms. The colleague is occasionally required to walk; climb or balance; stoop, kneel, crouch, or crawl; and taste or smell. The colleague must frequently lift and/or move more than 25 pounds. Specific vision abilities required by this job include close vision. The work environment characteristics described here are representative of those a colleague encounters while performing the essential functions of this job. There will be possible exposure to infectious diseases through working with clinical caregivers. The noise level in the work environment is usually quiet. 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 colleagues 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. Estimated salary range $13.28 - $22.19 / hour. Actual salary will vary by geographic location and experience. For the safety and health of our patients and Colleagues, Compassus complies with federal and state guidelines in terms of vaccine mandates. Compassus requires all program colleagues to be fully vaccinated for COVID-19 or receive an approved medical or religious accommodation, per the requirements of the CMS Mandate. At Ascension at Home - Together with Compassus, our mission is to provide home health and infusion care to critically ill patients and their families with Compassion, Integrity, and Excellence. Our associates and colleagues are committed to keeping The Promise by delivering the highest quality of care, serving the needs of patients and families and spreading the stories of those whom they come into contact. Our goal is to provide the greatest possible comfort and care for those who experience one of life’s most intimate and challenging moments. The people that make up Ascension at Home - Together with Compassus are dedicated to compassionate care, clinical excellence and providing comfort and support to patients and their families. Our organization employs more than 7,000 Associates/Colleagues who provide a range of services and other resources to benefit patients and families. Our primary goals are to provide the highest quality care and service in the communities in which we operate and to be the employer of choice in those areas. If your work ethic and belief system aligns with ours and you would like to work in an inspiring and professional atmosphere, we encourage you to explore career opportunities with Ascension at Home - Together with Compassus.

Salary : $13 - $22