Insurance Verification & Authorization Specialist

Graham Healthcare Group; Washington (District of Columbia); Hybrid; USD 25,000 - 30,000; Full time

Benefits offered by this job

Competitive Pay

Health & Dental Insurance

Life & Disability Insurance

Generous PTO

401k & Pension

Tuition Discounts

Job summary

Graham Healthcare Group in Washington, DC seeks an Insurance Verification & Authorization Coordinator to ensure benefit information and authorizations are obtained before care starts. You will work with multiple departments and manage EMR-based workflows in HomeCare Homebase.

The role requires an associate degree or equivalent, one year of experience in verification or medical billing, proficiency with MS Office, and availability weekends/holidays.

Qualifications

• Associate degree or combination of experience and business courses preferred.
• Minimum of one (1) year of previous experience in insurance verification, authorization, or medical billing.
• Proficiency in Microsoft Office Suite.
• Knowledge of Medicare, Medicaid, and third-party insurance and authorization requirements.
• Knowledge of insurance websites.
• Knowledge of HomeCare Homebase preferred.
• Conscientious, with attention to detail.
• Demonstrated patience, flexibility, and cooperative attitude.
• Ability to think critically and act independently when resolving benefit discrepancies.
• Effective verbal and written communication skills with others both internally and externally.
• Ability to work independently and within a multidisciplinary team.
• Availability weekends, holidays, and after hours based on business needs.

Responsibilities

• Obtain detailed and accurate benefit information using payer portals, phone, or fax for all insurance companies accepted by Home Health product lines
• Validate and document all payor information such as patient name, DOB, and policy number in the EMR
• Reduce write-offs by clearly documenting benefit information such as deductibles, co pays, co-insurance, and out-of-pocket maximums in the patients’ charts through coordination notes
• Continuously monitor task flow screen related to all insurance issues including but not limited to the following: verify Medicare eligibility, follow up to on-call completed insurance, complete insurance verification, review eligibility alerts, obtain initial authorization, re-verify insurance at recertification, and resumption of care
• Review of entitlement verification reports daily, researching any questionable answers
• Review problems related to all insurance changes daily
• Review of issues related to funding source updates daily
• Reverify current Medicaid patients to monitor HMO status monthly
• Reverify current patients’ insurances monthly to monitor for any payer changes or other agencies monthly
• Contact patients, hospitals, or physician offices for information or to clarify benefit
• Assist scheduling with funding source problems related to scheduling out visits to clinical staff
• Reduce write-offs by working with the clinical staff to ensure transfer of agency/provider of choice forms are received and sent to the other agency within the appropriate timeframes
• Obtain detailed and accurate authorization, prior authorization, and ongoing authorization as required by insurance companies accepted by the company via phone, fax, or payer portal
• Understand and maintain the authorization tab in HCHB
• Provide clinical information as requested by insurance companies
• Contact insurance companies as needed to review authorization submissions and requests for more clinical information and notify internal clinical staff of authorization approvals and denials
• Continuously monitor task flow screen related to all authorization issues including, but not limited to the following: determine if reauthorization needed for new orders, follow up on on-call completed authorizations, obtain initial authorization, obtain reauthorization, and update pending authorization with actual authorization information
• Assist scheduling with funding source problems related to scheduling out visits to clinical staff
• Assist billing department insurance verification discrepancies or authorization discrepancies which could hold up claim submission
• Establish a thorough knowledge of all payer portals
• Comply with the company’s Core Values and Core Competencies
• Perform other duties as assigned

Skills

Attention to detail

Communication

Independent worker

Patience & flexibility

Conscientious

Education

Associate degree or equivalent experience

Tools

Microsoft Office Suite

HomeCare Homebase

Job description

Graham Healthcare Group in Washington, DC seeks an Insurance Verification & Authorization Coordinator to ensure benefit information and authorizations are obtained before care starts. You will work with multiple departments and manage EMR-based workflows in HomeCare Homebase.

The role requires an associate degree or equivalent, one year of experience in verification or medical billing, proficiency with MS Office, and availability weekends/holidays.