Job Details

Become a part of our caring communityRemote full-time position, 8‑hour shifts, Monday‑Friday from 9am‑5:30pm CST / 10am‑6:30pm EST.Healthcare Insurance Authorization SpecialistReports directly to the Authorization Supervisor and is 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 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 perform follow‑up to ensure accurate, timely payments are made to 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 with the accounts receivable requirements.Ensure all payer requirements are met accordingly, including pre‑certification requirements, notification requirements, and level‑of‑care change required documents.Alert 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 confidentiality of patient/client and agency information.Maintain accurate and up‑to‑date information for all vendor and nursing facility contracts.Keep information in an orderly manner readily accessible for review and present status as requested.Assure compliance with local, state and federal laws, Medicare regulations, and established company policies and procedures.Participate in special projects and perform 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 impactRequired Experience/SkillsOne or more years of related experience and/or training preferred.Two or more years of Home Healthcare or Medical Office experience preferred.Knowledge of insurance reimbursement and authorization process preferred.Proficient in using computers and Microsoft Office applications, including Word, Excel, and Outlook.Two‑year college degree preferred.Additional InformationAt minimum a download speed of 25 Mbps (download) and 10 Mbps (upload) 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 California, Illinois, Montana or South Dakota will receive a bi‑weekly payment for their internet expense.Home or Hybrid Home/Office employees will receive telephone equipment appropriate to business requirements.Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.TravelOccasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours40Pay Range$43,000 – $56,200 per yearDescription of BenefitsHumana offers medical, dental and vision benefits, a 401(k) retirement savings plan, paid time off, short‑term and long‑term disability, life insurance and many other opportunities.Equal Opportunity EmployerHumana does not discriminate against any employee or applicant for employment based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. Humana complies with Section 503 of the Rehabilitation Act and VEVRAA and bases all employment decisions on valid job requirements.#J-18808-Ljbffr