Stonerise Home Health and Hospice
Authorization and Verification Specialist
POSITION SUMMARY:
The Authorization and Verification Specialist will work in combination with Intake and Agency teammates and any external authorization and verification vendors to ensure our processes and workflows are executed successfully, set goals and best practices are achieved, and the risk of lost revenue is minimized. In this role, you will be driving both internal and external customer satisfaction through a focus on faster and more efficient reimbursement. The ideal candidate will not only ensure a positive experience for patients, providers, and fellow teammates, but will also be a key contributor in optimizing and standardizing authorization and verification workflows.
CORE RESPONSIBILITIES:
- Submit authorization requests timely, following payer specific guidelines
- Partner with front desk teammates within clinics to ensure appropriate and accurate documentation for authorization submission is completed and uploaded for submission
- Provide regular regarding areas of opportunity in authorization or verification timeline or process
- Address and respond to authorization or verification related queries
- Ensure all authorization and verification related denials are addressed timely and accurately, providing denial prevention feedback to Intake and Agencies as needed
- Accurately and timely complete verifications by contacting the provided insurance via phone, fax, or online portal to obtain benefits, eligibility, and authorization information
- Request, follow-up, and secure authorizations communicating appropriately with Agency teammates to ensure timely patient care
- Complete Monthly eligibility verification and partner with Agency teammates to ensure follow-up is completed for ineligible results. Open new chart when a change is to an in-network carrier
- Assist with training and education of new teammates as well as ongoing training and education for established team members
- Maintain a professional and collaborative relationship with all teammates and vendors to resolve issues, increase knowledge of insurance requirements, and create standardized workflows
- Perform other duties as assigned by leadership staff
QUALIFICATIONS & SKILLS:
Experience Home Health Intake and or Insurance Verification- Demonstrates flexibility in responding to priorities and organizational change
- Demonstrates ability to work under pressure and follow through on assignments
- 2-3 years previous experience in pre-auth verification; experience with obtaining authorizations, referral coordination, and patient services preferred
- Ability to multi-task, prioritize needs to meet required timelines
- Customer service experience
- Effective written and verbal communication skills
- Solution oriented mindset and ability to use critical thinking and analytical skills
