2.0 - 6.0 years

0 Lacs

kochi, kerala

On-site

The Authorization Specialist plays a crucial role in ensuring timely and accurate authorizations for home health and hospice care services. You will be responsible for coordinating patient eligibility verification, managing authorizations, and maintaining comprehensive communication with clinicians, intake coordinators, and insurance providers. In the Authorization Process, your key responsibilities will include reviewing referrals to check for home health and hospice referrals with scheduled Start of Care (SOC) dates in the Excel file. You will access and pull the patient's chart in MatrixCare for further verification. Confirming patient eligibility for home health or hospice services by verifying active insurance plans and ensuring the service provider is in-network with the insurance provider will also be part of your tasks. Printing patient eligibility and benefits from the insurance portal and attaching it to the patient's chart in MatrixCare will be essential. You will need to wait for patient confirmation before obtaining authorization and tag the patient as admitted if the patient agrees and has a scheduled SOC. Verifying if there is a plotted visit on the patient's profile and refraining from requesting authorization if none is found will be required. Additionally, reviewing communication logs for notes from intake coordinators regarding authorization requests prior to requesting authorization and checking for re-authorization needs if new orders for continued care are received will be part of your responsibilities. In terms of Documentation and Record Keeping, you will upload Clinical Documents such as SOC OASIS, Plan of Care (POC), and Evaluation/Visit Notes into the patient's chart in MatrixCare. Leaving a detailed note in MatrixCare outlining the actions taken regarding authorization and inputting the authorization number, policy number, effective date (SOC date), and your name in the authorization details section to confirm the handling of authorization concerns will also be crucial. For Auditing and Monitoring, you will conduct daily audits of patient calendars to compare authorized visits against requested visits. Regularly monitoring emails and faxes for relevant communications and documentation will be necessary. Additionally, uploading any additional clinical information received from clinicians, referral sources, or facilities where the patient was discharged and requesting clinical documents and POC by email from the assigned supervisor or nurse as necessary will be part of your role. Emailing clinicians to prompt the closure of notes to facilitate authorization requests will also be part of your responsibilities.,

Posted 1 day ago

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