Home Health and Hospice Authorization Representative

Jobtailor; South Jordan (UT); On-site; USD 41,000 - 62,000; Full time

Job summary

Jobtailor is seeking an Eligibility & Authorization Specialist in Utah to verify insurance coverage, obtain authorizations, and support accurate patient billing in a clinical setting. The role requires bilingual Spanish communication and experience with Epic EMR systems.

Your responsibilities include reviewing eligibility responses, estimating patient costs, and collaborating with physicians and insurance companies to resolve issues, while ensuring timely, accurate recordkeeping.

Qualifications

• Two years of customer service experience required.
• Demonstrated good communication and computer skills.
• Experience utilizing Epic and other EMR systems.
• Experience in a clinical healthcare setting.
• Experience managing claims and appeals processes.
• Knowledge of medical terminology.

Responsibilities

• Obtain insurance eligibility and benefits information and communicate results.
• Obtain authorizations and notify insurance companies as needed.
• Review eligibility responses and coordinate with physician offices and insurers.
• Estimate patient responsibility and cost of service.
• Refer cases with questionable coverage to Eligibility Counselors.
• Correct patient records to prevent denials and billing problems.

Skills

Customer Service

Communication Skills

Epic EMR Experience

CPT/ICD-9 Code Knowledge

Billing and Collections

Bilingual Spanish

Tools

Epic

EMR Systems

Job description

• Obtain insurance eligibility and benefits information
• Obtain required authorizations and notify insurance companies of patient arrival as needed
• Review insurance eligibility responses and communicate with physician offices and insurance companies
• Work with Utilization Review staff to ensure authorizations cover needed services
• Estimate cost of service and patient responsibility
• Refer patients with questionable or at-risk insurance coverage to Eligibility Counselors
• Communicate reimbursement-affecting account changes to nursing and billing staff
• Correct patient records to prevent denials and billing or reimbursement problems
• Resolve insurance eligibility and authorization issues with physicians and patients
• Interpret 271 responses and insurance terminology to determine patient responsibility
• Perform calculations using insurance benefit information
• Maintain workload and performance standards
• May mentor, lead, or train new employees

Requirements

• Two years of customer service experience
• Demonstrated good communication and computer skills
• Demonstrated experience utilizing Epic and other electronic medical record (EMR) systems
• Experience working within a clinical healthcare setting
• Experience managing claims and appeals processes
• 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
• Ability to communicate information to others
• Ability to operate computers and other office equipment
• Ability to see and read computer monitors and documents
• Ability to remain sitting or standing for long periods while working on a computer, telephone, or other equipment

Core Competencies

Demonstrates expertise in insurance eligibility verification, authorization processes, and medical terminology within a clinical healthcare setting. Proficient in utilizing Epic and EMR systems to manage claims and ensure accurate patient billing.

Highest-signal resume keywords

• Insurance Eligibility Verification
• Utilization Review Collaboration
• Claims Management
• Bilingual Spanish Communication
• Medical Terminology Knowledge

ATS Optimization Keywords

Hard Skills

• Insurance Authorization
• CPT/ICD-9 Code Knowledge
• Cost Estimation
• Patient Record Correction
• Calculations Using Insurance Benefits

Soft Skills

• Good Communication Skills
• Mentoring and Training

Industry Keywords

• Clinical Healthcare Setting
• Customer Service Experience
• Billing and Collections
• Insurance Verification
• Claims and Appeals Processes

Tools & Technologies

• Epic
• Electronic Medical Record (EMR) Systems