Revenue Cycle Authorization Specialist

Company:

Compassus

 

Position Summary

The Revenue Cycle Authorization Specialist is responsible for modeling the Compassus values of Compassion, Integrity, Excellence, Teamwork, and Innovation and for promoting the Compassus philosophy, using the 6 Pillars of Success as the foundation. S/he is responsible for upholding the Code of Ethical Conduct and for promoting positive working relationships within the company, among all departments, and all external stakeholders. The Revenue Cycle Authorization Specialist is primarily responsible for obtaining authorization for all healthcare services ordered for all payers that require an authorization.

Position Specific Responsibilities

• Obtains authorizations in a timely manner.
• Reviews the insurance verification and completes the authorization process within established time frames. Accurately enters data into software program.
• Receives MD order and coverage authorization from agency designee. Works closely with agency to meet established timelines.
• Works closely with and supports team efforts to accomplish authorization/verification.
• Requests authorization from insurance company case manager to provide specific services and parameters of care.
• Provides effective communication to patient/family, team members, and other health care professionals and maintains confidentiality.
• Performs other duties as assigned.

Education and/or Experience

• High school diploma or GED required.
• One (1) or more years of insurance authorization experience preferred.
• Prior experience in home health, hospice, palliative, or infusion preferred.
• Utilization management experience and pre-certification helpful.
• Customer service experience desired.

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 hospice philosophy. Understanding of basic computer knowledge. Knowledge of Microsoft Word and Excel required. Working accounts in a computerized automated environment. Uses independent and critical thinking skills to achieve assigned objectives. Ability to organize and prioritize. Attention to detail. Ability to be accurate and timely. Good decision-making skills. Ability to maintain confidential 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.

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