Authorization Specialist

Home Caregivers Partnership LLC; Loveland (CO); On-site; USD 42,000 - 56,000; Full time

Job summary

Canyon Home Care & Hospice is expanding and seeking a dedicated Authorization Specialist to join our Loveland, CO office. You will manage day-to-day processes to verify patient eligibility and obtain authorizations for exams, ensuring timely payments from accepted payers.

Key duties include coordinating with health plans, gathering medical records, and maintaining accurate patient data to support prompt approvals and smooth operations in a busy office environment.

Qualifications

• Current knowledge of medical terminology, insurance authorization and verification.
• ICD-Codes/CPT knowledge preferred.
• Strong technical skills with Word, Excel, Acrobat or similar.
• Completion of state-mandated continuing education requirements.
• Excellent verbal and written communication and interpersonal skills.
• Ability to work in a fast paced setting.
• Knowledge of regulatory requirements at federal, state and local levels and agency policies.
• At least 21 years of age.

Responsibilities

• Verify patient eligibility and obtain authorization for all exams scheduled.
• Contacts patients/referring offices for updated insurance information and medical records to minimize pending exams.
• Ensure that exams are authorized 48 hours before service; same-day add-ons authorized before completion; other payers within 24 hours after.
• Work with health plans to provide medical records and data to ensure most exams are paid.
• Coordinate with internal departments to keep patient insurance information accurate and current.

Skills

Medical terminology

ICD/CPT knowledge

MS Office skills

Continuing education

Verbal & written comms

Fast-paced environment

Regulatory knowledge

Age 21+

Job description

Canyon Home Care & Hospice is growing, and we need great people to join us! We are looking for a full-time Authorization Specialist to work in our Loveland office. The right person will be detail-oriented, able to utilize technology effectively, work well in a busy office environment, and be dedicated to connecting patients with high-quality care.

JOB SUMMARY

The Authorization Specialist is responsible for the day-to-day processes to verify patient eligibility and obtain authorization for all exams scheduled to ensure timely payments from all accepted payer. The typical daily work load consists of the following: eligibility investigations via phone and online web portals, obtaining authorizations, collecting supporting clinical data from patients and/or referring offices and updating all information.

RESPONSIBILITIES

• - Manage the predetermination, authorization, and referral requirements of each health plan and meeting the requirements prior to the delivery of services.
• - Contacts patients and/or referring offices for updated insurance information, medical records and/or additional clinical data to ensure that no more than 5% of all exams end up in pending clinical.
• - Cross reference daily schedule and work queue to ensure that all scheduled exams are authorized forty-eight (48) hours prior to the date of service.
• - Cross reference daily schedule and work queue to ensure that all same day add-ons are authorized prior to the completion of the exam; other payers must be authorized within twenty-four (24) hours following the completion of the exam.
• - Work with each health plan to provide medical records and/or additional clinical data to ensure that 99% of all completed exams are approved for payment.
• - Communicate and coordinate effectively with internal departments to ensure patient insurance information is accurate and updated.

QUALIFICATIONS

• - Current knowledge of medical terminology, insurance authorization and verification.
• - Knowledge of ICD-Codes/CPT preferred.
• - Strong technical skills (Word, Excel, Acrobat or similar product).
• - Successful completion of or the ability to successfully complete any state required continuing education requirements.
• - Excellent verbal and written communication skills and strong interpersonal skills.
• - Ability to work in a fast paced setting.
• - Knowledge of regulatory requirements at the federal, state and local levels, as well as knowledge of Agency policies and procedures.
• - At least 21 years of age.