Home Health and Hospice Authorization Representative

Intermountain Health; South Jordan (UT); Hybrid; USD 54,068,000 - 73,383,000; Full time

Job summary

Intermountain Health seeks an Eligibility & Authorization Coordinator to join the Home Services team in Salt Lake City/South Jordan, Utah. The role focuses on obtaining insurance eligibility, benefits information, and required authorizations, while coordinating with physicians, insurers, and billing staff to ensure timely reimbursement.

Experience with Epic EMR is preferred; bilingual Spanish is a plus. Schedule is Monday–Friday, 8:30am–5:00pm with hybrid work options.

Qualifications

• Two years of customer service experience.
• Demonstrated good communications and computer skills.

Responsibilities

• Obtains insurance eligibility and benefit information using various phone and on-line resources.
• Obtains appropriate authorizations and notifies insurance companies of patient arrival as needed.
• Works with Utilization Review staff and/or physicians' offices to assure eligibility and authorization requirements are completed within the required timeframe.
• Communicates with nursing and/or billing staff when changes are made to the account that will affect reimbursement.
• Makes corrections in the patient's record to prevent denials and ensure billing accuracy.
• References at-risk admissions to eligibility as needed.
• Works with responses and reports to resolve issues and prevent delays in billing.
• Maintains performance and workload standards.
• Estimates cost of service using ICD-9 or CPT codes.
• Interprets 271 responses to determine patient responsibility.
• Performs calculations using insurance benefit information to estimate patient responsibility.
• May lead/train new employees in account preparation.

Skills

Customer service

Communication

Computer skills

Tools

Epic EMR

Billing software

Job description

Hybrid Work

Home Services - Salt Lake City

Full time

R183280

Job Description

This position is responsible to obtain insurance eligibility and benefits information and obtain required authorizations. Reviews all insurance eligibility responses and communicates with the physician's office and insurance companies as needed regarding these responses or to obtain correct information. Works with Utilization Review staff to ensure authorizations cover services needed. May also estimate cost of service and patient's responsibility. Refers patients with questionable insurance coverage to the Eligibility Counselors. May assist in mentoring new hires.

The hiring manager is considering candidates with demonstrated experience utilizing Epic and other electronic medical record (EMR) systems, working within a clinical healthcare setting, and managing claims and appeals processes

Schedule – Monday – Friday 8:30am – 5:00pm

Job Essentials

• Obtains insurance eligibility and benefit information using various phone and on-line resources.

• Obtains appropriate authorizations and notifies insurance companies of patient arrival as needed.

• Works with Utilization Review staff and/or physicians' offices to assure eligibility and authorization requirements are completed within the required timeframe.

• Communicates with the appropriate nursing and/or billing staff when changes are made to the account that will affect the reimbursement.

• Makes appropriate corrections in the patient's record to ensure accuracy in order to prevent denials and/or problems with billing and reimbursement.

• Immediately refers 'at risk' admission to eligibility, i.e., out of network, underinsured, max benefits, etc.

• Works with insurance eligibility responses and other appropriate reports and works with physicians and patients as needed to resolve issues and prevent billing delays.

• Maintains a satisfactory level of performance and adherence to workload standards.

• Estimates cost of service using ICD-9 or CPT codes.

• Interprets 271 response, including insurance terminology, in online tool to determine patient responsibility.

• Performs calculations using insurance benefit information to accurately estimate patient responsibility.

• May lead and/or train new employees in account preparation and review functions.

Minimum Qualifications

• Two years of customer service experience.

• Demonstrated good communications and computer skills.

Preferred Qualifications

• Demonstrated knowledge of medical terminology.

• Experience in admitting, billing, collections, and/or insurance verification.

• Bi-Lingual Spanish speaking.

• Demonstrated knowledge of CPT/ICD-9 codes.

• Interact with others requiring the employee to communicate information.

• Operate computers and other office equipment requiring the ability to move fingers and hands.

• See and read computer monitors and documents.

• Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Location

Home Services - Salt Lake City

Work City

South Jordan

Work State

Utah

Scheduled Weekly Hours

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$18.85 - $25.61

We care about your well-being -- mind, body, and spirit -- which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

By applying for a position with Intermountain, I acknowledge that I will comply with all applicable Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment. I further acknowledge that outside employment or activities may not interfere with job responsibilities or create a conflict of interest with Intermountain. Actual or reasonably perceived conflicts may be grounds for disqualification from consideration or, if hired, corrective action up to and including termination of employment.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Intermountain Health's PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100 learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment. Learn more. (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/peak-program/)

All positions subject to close without notice.

Headquartered in Utah with locations in six primary states and additional operations across the western U.S., Intermountain Health is a nonprofit system of 34 hospitals, 400 clinics, a medical group of more than 4,800 employed physicians and advanced care providers, a health plan division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery.

Join our world-class team and embark on a career filled with opportunities, strength, innovation, and fulfillment.

The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor.

Thanks for your interest in continuing your career with our team!