Verification/Authorization Coordinator

Overview

Responsible for the verification of patient eligibility/benefits as well as obtaining authorizations, when required, for home care/hospice services from insurance payors.
Responsibilities

• Review referral information for accuracy in applicable EMR system supplied by the Care Center.
• Obtain authorizations where required while maintaining compliance to medical record confidentiality regulations.
• Obtain authorization from private insurance and all other payor sources requiring authorization via telephone, facsimile, or online systems while maintaining compliance to medical record confidentiality regulations.
• Obtain information from agencies, when necessary, to assist with receiving authorizations and reauthorizations from private insurance and all other payor sources.
• Assist other departments and Care Centers in the efficient collection of client and payor information to ensure accuracy.
• Enter all patient benefit and authorization information into applicable EMR system.
• Respond to calls, emails and other inquiries regarding the status of outstanding referrals and/or authorization information.
• Provide other administrative support to the department as needed.
• Complete Payor Information Form (PIF) and Payor Change Request Forms (PCR) when needed for the purpose of meeting payor and client's needs to ensure accurate reimbursement.
• Update Contracting Coordinator of payor information changes.
• Communicate efficiently, effectively, and timely to resolve issues pertaining to the verification and authorization processes.
• Access Medicare's Common Working File (CWF) to verify eligibility in the event a patient has termed coverage with private insurance carrier if applicable.
• Update Admissions Operations Manager and/or Director of needed team efficiencies and any system problems as they occur.
• Complies with policies, procedures and regulatory mandates including but not limited to abiding to the terms of the Amedisys Compliance Program.
• Perform other duties as assigned.

Qualifications

• High school diploma or equivalent
• Two (2+) years' experience in medical office/home health benefit verification or billing.
• Demonstrated knowledge of commercial insurance carriers' guidelines and criteria of verification, authorization, and reimbursement.
• Familiar with insurance billing and terminology.

• Post-Secondary Education or training in business or medical billing/collections.

Amedisys is an equal opportunity employer. All qualified employees and applicants will receive consideration for employment without regard to race, color, religion, sex, age, pregnancy, marital status, national origin, citizenship status, disability, military status, sexual orientation, genetic predisposition or carrier status or any other legally protected characteristic.