入院和预认证专员 家庭医疗和临终关怀
Intake and Precertification Specialist Home health and Hospice
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居家健康与临终关怀入院及预认证专员负责管理居家健康与临终关怀服务的入院、保险授权和患者转介的行政协调工作。该职位确保及时准确地进行预授权，维护文件，监控认证截止日期，支持拒付管理，并促进患者、提供方和内部团队之间的沟通，以确保高效的服务交付并符合付款人要求。
最低资格要求：
教育、认证和/或执照：
1. 高中文凭或同等学历。
经验：
1. 两年在保险验证、授权或医疗入院方面的工作经验。
核心职责与责任：此处描述的陈述旨在描述分配到此职位的人所执行工作的总体性质。它们不构成所有责任和职责的详尽列表。可能会分配其他职责。
1. 协调新患者转介的入院流程，包括从医疗提供方接收转介信息，进行保险验证并安排初始评估。
2. 作为患者、家属、转介来源和医疗专业人员关于转介和授权状态的主要联系人。
3. 使用 EPIC 或其他电子系统获取并记录初始和持续的授权编号。
4. 保持预认证、授权活动和转介沟通的准确文件记录。
5. 与保险公司沟通以获得服务的预先授权并解决授权相关问题。
6. 监控授权状态，确保不会错过任何认证或重新认证，确保计费目的的付款人顺序正确。
7. 在适当系统中输入并维护患者转介和保险信息。
8. 根据需要与临床人员协调安排初始评估。
9. 保持对 CPT 编码和 HCPC 的最新了解，以便能够对居家健康/临终关怀转介进行预认证/授权。
10. 协助处理拒付管理、审计和文件请求等事宜。
查看英文原文
Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position.
The Intake and Precertification Specialist – Home Health and Hospice is responsible for managing intake, insurance authorization and administrative coordination of patient referrals for Home Health and Hospice Services. This role ensures timely and accurate prior authorizations, maintains documents, monitors certification deadlines, supports denial management and facilitate communication between patients, providers and internal teams to ensure efficient service delivery and compliance with payer requirement.MINIMUM QUALIFICATIONS:
EDUCATION, CERITIFCATION, AND/OR LICENSURE:
1. High School Diploma or equivalent.
EXPERIENCE
1. Two (2) years’ experience in insurance verification, authorization or healthcare intake.
CORE DUTIES & RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an exhaustive list of all responsibilities and duties. Other duties may be assigned.
1. Coordinate the intake process for new patient referrals, including receiving referral information from healthcare providers, performing insurance verification and scheduling initial assessments.
2. Serves as the primary point of contact for patients, families, referral sources and healthcare professionals regarding referral and authorization status.
3. Obtain and document initial and ongoing authorization numbers using EPIC or other electronic systems.
4. Maintain accurate documentation of precertification, authorization activity and referral communications.
5. Communicate with insurance companies to obtain prior authorization for services and resolve authorization related issues.
6. Monitor authorization status to ensure no certifications or recertifications are missed ensuring proper sequencing of payors for billing purposes.
7. Enter and maintain patient referral and insurance information in appropriate systems.
8. Coordinate scheduling of initial assessments with clinical staff as needed.
9. Maintain current knowledge of CPT coding and HCPC’s in order to be able to precertify/authorize home health/hospice referrals.
10. Assist with denial management, audits, and documentation requests as needed.
11. Track referral activity and ensure timely processing to support admission and billing.
12. Communicate with internal departments regarding authorization status and referral progress.
13. Demonstrates ability to maintain established productivity and throughput expectations in a high-volume referral environment.
14. Ability to manage multiple priorities simultaneously while maintaining accuracy, efficiency and timeliness.
15. Consistently meets required turnaround times and deadlines related to referral processing, authorization and documentation.
16. Provides exceptional customer service to patients, families and referral sources and care teams, ensuring seamless and positive experiences.
17. Demonstrates strong attention to detail whole working in a fast paced, deadline driven environment.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
SKILLS AND ABILITIES:
1. Knowledge, by experience, testing, or academic course work completion of CPT, ICD 10, HCPC, LMRPs, and similar coding/guidelines for purposes of being able to abstract medical record information sufficient to collect the necessary information acceptable to the third party payor or other agency i.e. worker’s compensation program) that would grant authorization for post-acute care to provide specialty specific services,
2. Knowledge of third-party payor requirements, contracts, authorization and payment practices required as well as ability to maintain knowledge of contracts as they change over time; attention to detail in the case of payment dispute.
3. Knowledge of EPIC platform preferred, although others will be taken in consideration, if appropriate.
4. Able to complete tasks in a consistent manner.
5. Able to effectively communicate with the public and health care team in a courteous and professional manner.
6. Able to prioritize tasks and have the skill to multitask.
7. Medical terminology experience.
Additional Job Description:
Scheduled Weekly Hours:
40Shift:
Exempt/Non-Exempt:
United States of America (Non-Exempt)Company:
SHC WVUHS Home CareCost Center:
392 SHC Access AdministrationOriginally posted on Himalayas