Become a part of our caring community and help us put health first
The shift is Monday-Friday, 6am-2:30pm CT/7am-3:30pm ET.
As a Healthcare Insurance Authorization Specialist , you will be responsible for:
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.
Use your skills to make an impact
Required Experience/Skills:
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.
Two years college preferred.
Additional Information:
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
CenterWell Home Health offers a variety of benefits to promote the best health and well-being of our employees and their families. Our competitive and flexible benefits surround you with support the same way you do for our patients and members, including:
Health benefits effective day 1
Paid time off, holidays, and jury duty pay
Recognition pay
401(k) retirement savings plan with employer match
Tuition assistance
Scholarships for eligible dependents
Caregiver leave
Employee charity matching program
Network Resource Groups (NRGs)
Career development opportunities
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$43,000 - $56,200 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
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Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources
