Central Authorization Coordinator - Home Health & Hospice - Westerville, OH

It's fun to work in a company where people truly BELIEVE in what they're doing!

Our intention is to have employees who are passionate about making their personal mission statement come to life each day at work! Be it through providing healing, eradicating loneliness, contributing to efficiencies, streamlining processes, being dependable, sparking creativity or something else, the demonstration of HOW you do your job is just as important as WHAT you do in your job.

Alongside our valued employees, we are making a difference throughout the state of Ohio in the lives of those that need healthcare or those embracing the next chapter of their lives. Sustained members of our team demonstrate accountable behavior and share our values of customer service, innovation, integrity, inclusion, financial stewardship, leadership and care.

The Central Authorization Coordinator coordinates and processes all new and extended cases within the workflow of the Central Authorization Department through verification of insurances, setting up patient demographic and billing information, and submitting all insurance authorizations required by the payer with accuracy and knowledge of third party payers in accordance with company standards and federal, state, and local standards, guidelines, and regulations.

Essential Activities and Tasks

Authorization Verification and Management - 60%

• Completes all workflow assigned authorization tasks within primary workflow software in a timely and accurate manner, relating to home health and hospice services.
• Uploads and indexes all relevant documentation to client attachments within primary workflow software, specifically regarding authorization approval and updates.
• Submits all required authorizations utilizing payer-based web portals or fax, as applicable.
• Completes all necessary items required to finalize pending authorizations; subsequently updates primary workflow software with relevant changes to authorization status, frequency and dates.
• Responds to all email and phone requests from sites in a timely and professional manner.
• Escalates all known issues of concern to Division Manager of Accounts Receivable - HHH or Central Admissions Supervisor in a timely manner.
• Completes all recertification on existing authorizations, as supported by continuation of services by physician orders.
• Notifies site personnel of any existing issues relating to the validity and/or finalization of authorization of services rendered.
• Reviews authorization workflow for newly opened admission or recertification, verifies patient homebound status when required. If patient is no longer homebound, determines if alternative insurance available that doesn’t require homebound status.
• Completes coordination note of authorization activity to assure timely communication with locations and billing staff.
• Maintains accurate insurance plan knowledge of all prior authorization requirements (i.e. assuring alignment of patient orders, discipline visits and authorizations match requests).
• Tracks all appeals and appeal decisions to assure authorization requests are reconciled with visits. Communicates appeal decisions with locations.
• Updates pending authorizations by checking status of authorizations awaiting determination and contacting payors and verifying payor portals for results.
• Re-verifies patient eligibility and patient benefits monthly to assure patients’ insurance plans are still active.
• Responds to additional documentation requests from insurance plans for additional information required to provide necessary authorizations.
• Validates accuracy of central intake data input of patient demographic information and selection of primary payor based upon coordination of benefits.
• Works within electronic medical records software to process authorizations and denial appropriately and notifies location after authorization adjustments have been completed.

Appeal Tracking and Administration - 20%

• Sends medical record appeal packets sent by therapy vendors, Director of Nursing, Regional Directors of Clinical Operations (RDCO) and administrative staff.
• Enters all tracking information and appeal updates on the Additional Development Request (ADR) log.
• Systematically reviews Retrospective Post Payment Medical Record Reviews for takeback adjustments and clears entries over 90 days old that have not been adjusted or resubmitted by entering payment amount on ADR log.
• Communicates with Third Party Accounts Receivable Coordinators and RDCOs on all appeal correspondences and updates.

Data Entry - 20%

• Creates facesheet, as needed, and verifies that all demographic and billing information is accurate and complete through validation of patient-supplied information from the referring facility.
• Completes all Authorization related workflow tasks, as needed, for data integrity.
• Ensures statement set-up is complete prior to month-end close.
• Enters all authorization numbers for all services in billing systems in a timely and accurate manner.
• Tracks all outpatient start and end of care episodes in the electronic medical records system.
• May be responsible for therapy billing code entry.

All other duties as assigned.

Qualifications

Education

• High school diploma or equivalent required.

Experience

• Experience in insurance and billing required.
• Experience in long-term care, hospital, or other related healthcare accounting preferred.
• Experience with Medicare Advantage and Medicaid eligibility preferred.
• Proficiency with Windows, Microsoft Office (Word, Excel, PowerPoint), and the internet required.

Other Requirements

• Must be able to read, write, speak, and understand the English language.

Working Conditions and Special Requirements

• Sitting - Up to 8 hours/day
• Standing - Up to 2 hours/day
• Walking - Up to 2 hours/day
• Lifting, transferring, pushing or pulling equipment/supplies - Up to 25 pounds
• Driving - Up to 6 hours/day
• Work weekends, evenings, and holidays - As needed for coverage
• Risk Category for Exposure to Bloodborne Diseases - III