Authorization Specialist

Philadelphia, PA $17.00-$20.00/hour

Job description

All American Home Care, and its affiliates, delivers compassionate, high-quality care to patients and clients in their homes or places of residence, including non-medical personal assistance, skilled nursing and rehabilitation and hospice and palliative care. Our caregivers focus on each unique patient to deliver the appropriate care and emotional support to our patients and their families.

As a Authorization & Eligibility Specialist, you will:

  • Daily audit of admission, discharge and other source documentation to ensure revenue is recognized appropriately and all conditions of payment are met.
  • Verify patient eligibility and payor coverage guidelines to ensure that all necessary information is secured for timely, accurate revenue recognition
  • Weekly generation of site revenue and resolution of batch errors and bill holds as appropriate.
  • Weekly communication with site leadership detailing outstanding documentation or other issues resulting in a potential loss of revenue.
  • Prepare and submit invoices to Accounts Payable for reimbursement and performs follow up to ensure accurate, timely payments are made to our facility partners
  • Prepare, submit and follow up on authorization and re-authorization requests according to applicable state and commercial payor guidelines.
  • Coordinate, review, and analyze documentation and data entry supporting Medicare, Medicaid, and commercial payer requirements to ensure accurate and timely billing
  • Ensure all internal controls and related policies/procedures are implemented and followed in accordance to the accounts receivable requirements.
  • Ensure all payer requirements are met accordingly, including pre-cert requirements, notification requirements, and level of care change required documents.
  • Alerts appropriate team members at the Site regarding late or missing documents required for billing.
  • Establish and maintain positive working relationships with Sites, Nursing Home Facilities, and AR Teams.
  • Maintain the confidentiality of patient/client and agency information at all times.
  • Maintain accurate and up to date information for all vendor and nursing facility contracts.
  • Keep information in an orderly manner readily accessible for review. Presents status as requested.
  • Assure for compliance with local, state and federal laws, Medicare regulations, and established company policies and procedures
  • Participate in special projects and performs other duties as assigned.
  • Assist with training of newly-hired associates, as well as re-education of revenue teams as necessary.
  • Act as an information resource for any hard revenue generation issues or system issues. Basically the subject matter expert.
  • Assure the completion and coordination of work in an associate’s absence, or as needed to maintain departmental standards.

Qualifications:

  • One to two years related experience and/or training preferred.
  • Two years Home Health care or Medical Office experience preferred.
  • Knowledge of insurance reimbursement and authorization process preferred.
  • Skilled in the use of computers and the Microsoft Office applications.
  • SAP and/or HealthCare System knowledge is preferred.
  • Two years college preferred.

Please visit our careers page to see more job opportunities.

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