Insurance Management Specialist I- Full Time, Days, 9a - 5p, Atlantic Health Visiting Nurse

Duties & Responsibilities:

Communication

• Function as a liaison between external Insurance Companies and internal staff to ensure patient needs are met.
• Notify internal staff when patient updates are required.
• Communicates with CAC & Clinical Teams to ensure required financial information is available to review with patient.
• Communicate with Clinical Teams to request necessary information for ongoing authorizations in a timely manner.

Insurance Verification

• Verifies patient insurance for all incoming referrals for all payers.
• Verifies patient insurance during course of episode if payer change occurs or a need for re-verification arises.
• Participates in the re-verification at designated times of year, i.e. open enrollment period.
• Documents all verification information in EPIC to ensure CAC, clinical teams and other departments are aware of results.

Authorization

• Obtain timely initial precertification and authorization for initial services when required.
• Understands and enters pending authorization as required.
• Demonstrated knowledge of payors and required documentation for precertification and authorization.
• Obtains timely authorization for ongoing authorizations for home care and hospice services from select payers online, by telephone or fax per company requirements.
• Documents all authorization information in Epic to ensure clinical communication, as well as accurate system notification of ongoing needed authorization.
• Reviews additional service request for completeness of information, accuracy and presence of required clinical data.
• Request and /or submit clinical documentation for authorization/reauthorization in Epic, prepares updates as indicated.

Department Workflow

• Ensures coverage of department for assigned hours of operations.
• Manages assigned patient, insurance and/or acct EPIC work queues, ensuring accurate and timely completion.
• Supports data integrity by running or working reports to identify and correct areas of inaccuracy.
• Participates as needed in the follow-up and correction of insurance and/or authorization information, including the process required for payer changes, or obtaining retro authorization.
• Participates as directed by Supervisor of Verification/Authorization in the EVV process.

Other Duties

• Performs other duties as assigned.

High School Diploma or GED required.

A college degree is preferred.

Experience/knowledge in obtaining authorizations and familiarity with insurance verification is highly desirable.