Home Health VNA

  • Utilization/Authorization Spec

    Job Locations US-MA-Lawrence
    Department
    Operations
    Job ID
    2018-2128
    # of Openings
    1
    Hours (posting)
    Regular Full-Time
    Hours Per Week
    37.5
    Shift
    Days
    Schedule From:
    8:00 AM
    Schedule To:
    4:00 PM
  • Overview

    Are you looking for an interesting and dynamic position in the growing field of home health care?  

     

    The Utilization Authorization Specialist assists with the coordination of managed care patients: follows procedures to obtain needed authorizations, documents necessary authorization/utilization information in patient electronic medical record, tracks appropriate utilization of services and has knowledge of reimbursement guidelines.

    Responsibilities

    • Obtain authorization for assigned managed care insurance programs for visits requested by clinicians.
    • Enters all authorized visits in the UR log along with the date, frequencies, ranges, disciplines, case manager’s name and telephone number.
    • Collaborate with the billing and referral departments to facilitate the many different processes required for managed care and billing.
    • Refer complex cases to UR nurse foreview. Is willing to coordinate and participate in case conferences as requested.
    • Review initial admission information to provide required clinical documentation to providers for authorization, utilization and payment.
    • Continually provides managed care organizations with clinical documentation to comply with the payers’ requirements to obtain reimbursement.
    • Alert clinicians and managers regarding need for additional authorization or delays in discharges.
    • Facilitates the timely transfer of the universal health care form to all managed care insurers.
    • Follows through in a timely manner to request/obtain service authorizations per the insurance defined procedures.
    • Enters all relevant email and voice mail messages received on to the UR log daily.
    • Keeps the UR Manager informed of any problems, changes and trends of any managed care process changes.
    • Continuously assess the clinical data to make sure the visits are medically necessary and meets managed care criteria (skilled, homebound, MD orders and reasonable).
    • Advocate for the patient to ensure quality outcomes and the delivery of appropriate clinical services.
    • Acts as a resource to all staff members, referral, and billing and outside providers to insure appropriate utilization.
    • Maintain knowledge of federal, state, JCAHO and managed care regulations as well as agency policies and procedures.
    • Foster a friendly, helpful atmosphere for clinical, billing and referral departments.
    • Communicate with staff regarding insurer requests for additional documentation.
    • Demonstrates knowledge of the CQI process.
    • Demonstrates a knowledge and understanding of what to report to the supervisor or Director of Quality Improvement when concerns of corporate compliance arise.
    • Ensures compliance within guidelines set forth by regulatory agencies (JCAHO, DPH, ERISA etc.) and demonstrates compliance with Home Health Foundation policies and procedures.

    Qualifications

    • Knowledge of insurance authorization/utilization process.
    • Exceptional documentation, communication and organizational skills.
    • Computer literacy required.
    • Customer Service Skills.
    • Insurance verification experience a plus.
    • Associate’s Degree Preferred.

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