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Responsibilities

As a Revenue Specialist/Healthcare Claims Authorization Specialist, you will:

• 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 that 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 performs follow up to ensure accurate, timely payments are made to our 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 to the accounts receivable requirements.
• Ensure all payer requirements are met accordingly, including pre-cert requirements, notification requirements, and level of care change required documents.
• Alerts 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 the confidentiality of patient/client and agency information at all times.
• Maintain accurate and up to date information for all vendor and nursing facility contracts.
• Keep information in an orderly manner readily accessible for review. Presents status as requested.
• Assure for compliance with local, state and federal laws, Medicare regulations, and established company policies and procedures
• Participate in special projects and performs 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.

Required Experience/Skills:

• One to two years related experience and/or training preferred.
• Two years Home Health care or Medical Office experience preferred.
• Knowledge of insurance reimbursement and authorization process preferred.
• Skilled in the use of computers and the Microsoft Office applications.
• SAP and/or HealthCare System knowledge is preferred.
• Two years college preferred.

Scheduled Weekly Hours