Insurance Verification Specialist, Home Health

This position provides the overall Insurance Verification, eligibility and authorization process for the agency as directed by the agency administrator, or designee, and is responsible for the daily record keeping as appropriate. Will assist with Billing Department as needed and directed by Operation Manager - Home Health, or designee. Responsible for following up with insurance companies, doctor's offices and intake department regarding authorization process for services as ordered by physician.
Responsibilities:

1. Verification of eligibility and benefits for Medicare and various insurance companies either electronically or by phone.
2. Working directly with the insurance company, healthcare provider, other company's departments staff to submit claims that are successfully processed and paid timely.
3. Answers questions from patients, clerical staff and insurance companies.
4. Identifies and resolves authorization/verification issues
5. Follows and reports status of authorized visits/services to Home Health staff, and agency management.
6. Participates in educational activities and attends meetings.
7. Maintains strictest confidentiality in accordance with federal, state and local regulations, in particular HIPAA.
8. Verifying patients' insurance coverage and authorizations.
9. Monitor and track authorization and utilization of covered service units, including communication with Home Health office staff to ensure services are not delivered outside of authorized units.
10. Managing the agency's Preauthorization Reports.
11. Verify insurance benefits for changes monthly.
12. Ensures compliance with all federal and state regulatory requirements as it relates to enrollment and premium billing process and turn-around time frames.
13. Identifies control and/or process inefficiencies and proposes enhancements to the current process striving for continuous improvement.
14. Prioritize demands timely in an effort to address the most pressing needs for the business at any given time.
15. Organizes, investigates, resolves and reports issues in a timely and effective manner.
16. Maintain positive attitude & professionalism with both clients & colleagues.
17. Performs other task and projects, as needed.
18. Works with tech personnel to troubleshoot and resolve technical issues.
19. Knowledge of insurance industry changes including forms, authorization processes and websites.

• 4 + years of relevant Insurance Verification and authorization, and billing experience in the healthcare industry
• Successful in a fast-paced environment with ability to thrive in stressful situations
• Ability to find solutions and manage relationships across departments
• Ability to multi-task and to prioritize with limited direction
• Strong analytic aptitude and results oriented with great attention to detail.
• Ability to define problems, collect data, establish facts and draw valid conclusions. Ability to interpret an extensive variety of technical instructions.
• Demonstrated ability to work in a team environment that requires quick turnaround and quality output.
• Ability to communicate with others, including customers, in a clear, understandable and professional manner on the phone, via email and in person; and the demonstrated use of good written (i.e. good grammar/spelling) and verbal communication skills.
• Strong computer skills including working with various billing programs as well as word processing and spreadsheets

• Ability to participate in physical activity.
• Ability to work for extended period of time while standing and being involved in physical activity.
• Moderate/heavy lifting
• Ability to do extensive bending, lifting, and standing on a regular basis