Reports directly to the Sr. Director of Central Intake and is responsible for completing referrals using gathered information to provide data necessary to coordinate service eligibility, insurance verification, authorization and care coordination, handles requests for facilitating problem-solving of referral source information specific to coordination of patient admissions, and ensures maximum third-party reimbursement through monitoring insurance verification and authorization process. This position also communicates with provider/clinical staff/caregivers as necessary to obtain pertinent information and acts as the point of contact, aiding providers and organization.Organization CommunicationHandles all daily patient referrals and intake operations and reviews and processes pending referrals.Enters all demographic and insurance information for new customers and updates as needed.Completes registration of clients into the home care management program in an accurate and timely mannerInforms location staff of received referral/s with full details on deductible, coinsurance and copay.Adheres to the rules regarding confidentiality of HIPAA protected health informationAssists with the identification and reporting of potential quality management and non-coverage issuesCommunicates with relevant parties to obtain authorization of home health services, initial and ongoingInterfaces with providers/office staff/clinical staff/caregivers for the purpose of attaining additional information required for authorization approvalProvides direct support regarding utilization, authorization, and referral activitiesContacts providers and families with authorization, denial, and appeals process informationCompletes monthly authorization expiry reports and informs location of upcoming renewalsCompletes any and all changes to health insurance in KanTimeVerificationVerifies eligibility of members and member benefit coverage at initial start of care and ongoing eligibility and benefits verification on the 1st and 15th of each monthReports all discrepancies to the Director of Clinical Services, Director of Therapy, Account Manager, and Director of Central IntakeInsurance knowledge experienceGeneral knowledge of state Medicaid plans, private insurance plans, Medicare and Veteran AffairsPerforms all other duties assigned by Director of Central IntakeSupports and executes the mission, ethics, and goals of the company effectively Represents themselves in a positive and professional manner in the company and communityAdheres to dress code with a clean and neat professional appearanceReports on time and as scheduled to complete work within designated timeAdhere to all company policies and procedures outlined in Employee Handbook, Employee Agreement, or communicated from executive team
