Company: Providence at Home with Compassus
Position Summary This position is responsible for maintaining initial authorizations, re-authorizations and level of care change authorizations. Responsible for developing and maintaining strong relationships with managed care and private insurance companies. Works in conjunction with the Regional contracting department to ensure Providence TrinityCare has a current viable contract with managed care and private insurance companies. Provides tools and necessary training to intake/admissions department to allow staff to obtain basic authorizations. Interacts with the department supervisor and acts as a liaison between the Regional billing office and clinical leaders as well as team administrative assistants to ensure clean billing records.
Position Specific Responsibilities - Performs complex and managed care insurance verifications including initial authorization, re-authorization and level of care change authorizations in a timely manner.
- Develops relationships with Managed Care and Private insurance companies in support of obtaining timely insurance authorizations, reauthorizations and/or approvals for level of care changes.
- Accurately documents insurance information in EMR System within established documentation standards for Providence TrinityCare.
- Communicates all necessary information to the appropriate clinical supervisor or manager to ensure coverage and benefits are clearly understood including any coverage limitations, medication carve outs or non-coverage, or potential impact to services within patient plan of care.
- Reports any inconsistencies in verification to the Clinical Supervisor, Call Center or appropriate Clinical leader.
- Informs the department supervisor of any quality issues.
- Works in conjunction with the Regional billing office and clinical supervisors and/or managers to ensure claims are accurate.
- Works with Regional contracting department to ensure managed care and private insurance company contracts are in place and are accurate.
- Demonstrates the ability to be flexible and adapt to changes.
- Consistently maintains composure under pressure.
- Understands the role of Insurance liaison and how the function relates to the overall patient care and Organizational revenue.
- Ensures all required documentation is obtained, documented, and entered into the EMR System in compliance with established documentation standards.
- Ensures quality customer service is provided at all times, and assists with answering incoming calls as needed.
- Accurately enters patient account information into the information systems in a timely manner and ensures correct benefits are recorded in the EMR.
- Maintains productivity standards set by organization guidelines.
- Documentation / Information Management:
- Demonstrates working knowledge of the overall TrinityCare and hospital (EPIC) electronic health records, and other electronic medical records systems, as required.
- Provides insurance companies with required documentation on patient accounts as related to the authorization for services.
- Assists and trains call center staff on verifying Medicare coverage and/or obtaining electronic authorizations from managed care or private insurance.
- Follows Providence policy regarding sign-on and sign-off to Providence information systems and never shares passwords.
- Leadership / Supervision:
- Participates in orientation, education and development of team members as directed by supervisor.
- May be assigned to assist in the training of new personnel.
- Acts as a department resource as needed.
- Development:
- Participates in appropriate continuing education as may be requested and/or required by immediate supervisor.
- Accepts personal responsibility for other educational activities to enhance job-related skills and abilities.
- Accepts responsibility for own professional growth by seeking out appropriate education programs.
- Performance Improvement:
- Establishes and maintains positive working relationships with employees and other customers.
- Maintains confidentiality of employee and organization information at all times.
- Participates in the Performance Improvement Program and participates in and adheres to the TrinityCare Corporate Integrity Plan.
- Budgetary:
- Follows Core Value for being financially prudent.
- Performs other duties as assigned.
Education and/or Experience - Preferred - Coursework/Training Two years' college.
- Preferred - Coursework/Training Customer service training.
- Preferred - Coursework/Training Medical Terminology course.
- Required - 1 year Healthcare related accounts payable/accounts receivable experience.
- Preferred - 2 years Experience in a hospice/palliative care setting.
- Preferred - 1 year Hospice/home health/outpatient services related finance, billing and/or insurance verification experience.
Skills - Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percentage.
- Language Skills: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from leaders, team members, investors, and external parties. Strong written and verbal communications.
- Other Skills and Abilities: Ability to understand, read, write, and speak English. Articulates and embraces integrated healthcare at home philosophy.
- Computer Skills: Demonstrated competency with electronic patient care information management systems.
- Other Skills and Abilities: Requires the ability to establish and maintain a courteous and cooperative (service-oriented) working relationship with managed care/insurance companies, patients, families, hospice staff and co-workers.
- Other Skills and Abilities: Leadership ability.
- Other Qualifications: Knowledge of Medical Terminology preferred.
- Computer Skills: Accurate typing skills, 35 WPM preferred.
- Language Skills: Bilingual preferred.
Certifications, Licenses, and Registrations - Required upon request: Driving may be necessary as part of this role.
- Caregivers are required to comply with all state laws and requirements for driving.
- Caregivers will be expected to provide proof of driver license and auto insurance upon request.
- See policy for additional information.
Physical Demands and Work Environment: The demands of this role necessitate a team member to effectively perform essential functions. Adaptations can be made to accommodate team members with disabilities. Regular standing, walking, and manual dexterity are fundamental, along with the ability to lift and move objects up to 25 pounds. Visual acuity requirements include close and distance vision, color and peripheral vision, depth perception, and the ability to adjust focus. This description provides a general overview and may vary by role and department, capturing the nuanced demands and conditions inherent to positions in our organization.
At Compassus, including all Compassus affiliates, diversity, equity, and inclusion are fundamental to our Pillars of Success. We are committed to creating a fair work environment where our team members feel welcomed, highly valued, and respected. As an equal opportunity employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Compensation range: $20.80-34.66 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities
Compassus offers a comprehensive benefits package including, Medical, Dental, Vision, 401k and much more.
Build a Rewarding Career with Compassus At Compassus, we care for our team members as much as we care for our patients and their families. Through our Care for Who I Am culture, we show compassion, respect, and appreciation for every individual. Embark on a career that cares for you while you care for others.
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The Compassus Advantage • Meaningful Work: Make an impact every day by honoring the quality of life of our patients, supporting them and their families with compassion, and creating moments that truly matter.
• Career Development: Access leadership pathways, mentorship, and personalized professional development.
• Innovation Meets Compassion: Collaborate with a supportive team using the latest tools and technologies to deliver exceptional care.
• Enhanced Benefits: Enjoy competitive pay, flexible time off, tuition reimbursement, and wellness programs designed for your well-being click apply for full job details