Authorization Specialist (Transportation)

Insurance Authorization Specialist is a self-motivated individual that works closely with other departments to ensure proper insurance verification and coverage benefits for home health and Hospice patients. The insurance authorization specialist will calculate copay and or coinsurance rates for the billing team to collect the insurance authorization specialist will obtain authorization depending on the insurance. The insurance authorization specialist will be responsible for running all reports for expiring authorizations. The insurance authorization specialist will be responsible for gathering any additional documentation from the clinical staff to meet medical necessity for authorizations. The insurance authorization specialist will document in the patient chart all benefits, authorizations, co-pays / coinsurance charge slips, letters of agreement, insurance case manager contact information, and any additional documentation obtained that concerns benefits, coverage, or authorization.

Essential duties and accountability
· Utilize telephone, e-mail and online portals to verify coverage benefits, obtain authorizations and communicate with other departments regarding each patient's home health and Hospice benefits.
· Calculate copay and coinsurance balances to complete charge slips for admissions team and billing team to obtain payment.
· Communicate with insurance taste managers and motor vehicle accident attorneys for letters of agreements and visit limitations and authorization.
· Attend case conference meetings to coordinate with client clinical staff the remaining benefit limits and confirm medical necessity for ongoing home health services.
· Occasionally contact patient for clarification of insurance carrier and policy numbers.
· Occasionally contact patient for example explanation of workers compensation claim detail including obtaining name and contact information for case manager and dates of settlement.
· Runs weekly and daily reports to ensure all patients have adequate authorization for home health and Hospice services.
· Keeps abreast of changes and trends affecting insurance and authorizations
· All other duties as assigned
Special skills and abilities required
· knowledgeable user of computer systems in applications to include Microsoft Word, excel, and e-mail
· a keen eye for details.
· Ability to work methodically and meet deadlines
· insurance knowledge is a plus
· excellent interpersonal communication skills
· organization and time management skills ability to maintain flexibility in meeting department and individual workload demands
Education
· high school diploma or GED
· Experience with insurance verification and obtaining authorization is preferred
· demonstrate knowledge of appropriate skills for communicating with the individuals through verbal and written tools
Competencies
· build credibility and trust
· collaborate with others
· demonstrates interpersonal understanding and utilizes effective communication skills
· deliver results
· analyze problems and make decisions
· demonstrate resilience
· Learn continuously