Prior Authorization Specialist

 

 

 

Coordinates patient accounts from prior authorization to point of bill payment or referral to collection, including processing billing for home health agencies to appropriate agencies, including Medicaid and self-pay. Maintains current knowledge of changes in billing requirements and regulations and assists in resolving billing problems.

 

 

Essential Functions:

• Verifies patient insurance coverage and eligibility for homecare services.
• Processes and submits insurance claims for reimbursement.
• Communicates with patients, insurance companies, and healthcare providers to resolve billing issues.
• Maintains accurate and up-to-date patient records and billing information.
• Monitors and tracks outstanding claims and follows up on unpaid or denied claims.
• Ensures compliance with all relevant regulations and guidelines related to homecare billing and reimbursement.

Education Requirement:

High School Diploma or equivalent, required.

Licensure Requirement:

(not specified)

Certifications:

(not specified)

Skills:

(not specified)

Experience:

• Two years ofexperience billing public and private insurers for medical services using computerized billing system, required.
• Homecare services experience, preferred.

Physical Requirements:

OCCASIONALLY: Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Standing, Walking

FREQUENTLY: (none specified)

CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing – Far/near, Sitting

Additional Physical Requirements performed but not listed above:

Talking on the phone / in person Frequently (34 - 66%)

 

 

"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"