Authorization Coordinator - Home Health Job

Full Job Title: Authorization Coordinator - Home Health - PRN

Job Number: 17008139

Facility: SSM Health System Office

Location: St. Louis, MO

Schedule: Occasional/Subs

Hours: 8am-5pm

Description

Role Purpose:
Delivers excellence in customer service which meets and exceeds customer expectations. Reviews and analyzes home care patient cases to effectively communicate with case management and insurance companies to justify continuation of Home care. Responsible for retrieving, recording and communicating authorization of care. Educates referral sources regarding qualifying criteria. Serves as a patient advocate and liaison between referral sources, physician office, vendors, case managers, insurance companies and patients to provide information and education pertinent to the care of the patient. Ensures authorization and optimal reimbursement by payor sources, case managers and private individuals.
Responsibilities:
    • Communicates with medical professional, vendors, insurance company personnel, and case managers to expedite patient authorization of requested services.
    • Complies with all department policies. Meets assigned quotas of monthly authorizations.
    • Identifies clinical needs of the patient and communicates with case management/insurance companies/Home Care staff.
    • Communicates with medical professional, vendors, insurance company personnel, and case managers to expedite patient authorization of requested services for initial authorization and documents the information into Horizon.
    • Prints daily RR note report and notifies clinical staff of expiring authorizations.
    • Obtains and maintains current knowledge of insurance coverage's (authorization process, documentation requested), and then informs the necessary people of required information.
    • Notifies central intake, scheduling, and clinical supervisors if unable to obtain authorization.
    • Maintains and updates database processes for obtaining authorization from specific payors.
    • Acts as a contact for new and existing accounts and maintains data related to original referral.
    • Follows up on service batch weekly.
    • Performs other duties as assigned, such as special assignments.

Qualifications

Minimum Requirements:
  • Graduate of accredited school of nursing: Licensed Practical Nurse, Therapist or Therapist Assistant
  • Current Missouri LPN license and valid drivers license
  • 1 to 3 years of insurance verification/authorization experience required
  • Customer service focus and skills required
  • Must maintain an acceptable driver's record per company policy.
  • Must be able to maintain proof of current auto insurance with at least state required minimum coverage.
  • Requires effective oral and written communication skills to communicate with customers.
  • Requires good decision making and problem solving skills.
  • Knowledge of general computer skills including Windows required

SSM Health at Home –

SSM Health at Home offers highly skilled and experienced caregivers to help patients through difficult times. Services include extended at-home care, help managing pain or special support during terminal illnesses. SSM Health at Home is located in Illinois, Missouri and Oklahoma.

SSM Health is an Equal Opportunity and Affirmative Action Employer. Qualified applicants are considered for employment without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other characteristic protected by law. Learn More »


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