Intake and Precertification Specialist Home health and Hospice

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The Intake and Precertification Specialist – Home Health and Hospice is responsible for managing intake, insurance authorization and administrative coordination of patient referrals for Home Health and Hospice Services. This role ensures timely and accurate prior authorizations, maintains documents, monitors certification deadlines, supports denial management and facilitate communication between patients, providers and internal teams to ensure efficient service delivery and compliance with payer requirement.

MINIMUM QUALIFICATIONS:

EDUCATION, CERITIFCATION, AND/OR LICENSURE:

1. High School Diploma or equivalent.

EXPERIENCE

1. Two (2) years’ experience in insurance verification, authorization or healthcare intake.

CORE DUTIES & RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an exhaustive list of all responsibilities and duties. Other duties may be assigned.

1. Coordinate the intake process for new patient referrals, including receiving referral information from healthcare providers, performing insurance verification and scheduling initial assessments.

2. Serves as the primary point of contact for patients, families, referral sources and healthcare professionals regarding referral and authorization status.

3. Obtain and document initial and ongoing authorization numbers using EPIC or other electronic systems.

4. Maintain accurate documentation of precertification, authorization activity and referral communications.

5. Communicate with insurance companies to obtain prior authorization for services and resolve authorization related issues.

6. Monitor authorization status to ensure no certifications or recertifications are missed ensuring proper sequencing of payors for billing purposes.

7. Enter and maintain patient referral and insurance information in appropriate systems.

8. Coordinate scheduling of initial assessments with clinical staff as needed.

9. Maintain current knowledge of CPT coding and HCPC’s in order to be able to precertify/authorize home health/hospice referrals.

10. Assist with denial management, audits, and documentation requests as needed.

11. Track referral activity and ensure timely processing to support admission and billing.

12. Communicate with internal departments regarding authorization status and referral progress.

13. Demonstrates ability to maintain established productivity and throughput expectations in a high-volume referral environment.

14. Ability to manage multiple priorities simultaneously while maintaining accuracy, efficiency and timeliness.

15. Consistently meets required turnaround times and deadlines related to referral processing, authorization and documentation.

16. Provides exceptional customer service to patients, families and referral sources and care teams, ensuring seamless and positive experiences.

17. Demonstrates strong attention to detail whole working in a fast paced, deadline driven environment.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SKILLS AND ABILITIES:

1. Knowledge, by experience, testing, or academic course work completion of CPT, ICD 10, HCPC, LMRPs, and similar coding/guidelines for purposes of being able to abstract medical record information sufficient to collect the necessary information acceptable to the third party payor or other agency i.e. worker’s compensation program) that would grant authorization for post-acute care to provide specialty specific services,

2. Knowledge of third-party payor requirements, contracts, authorization and payment practices required as well as ability to maintain knowledge of contracts as they change over time; attention to detail in the case of payment dispute.

3. Knowledge of EPIC platform preferred, although others will be taken in consideration, if appropriate.

4. Able to complete tasks in a consistent manner.

5. Able to effectively communicate with the public and health care team in a courteous and professional manner.

6. Able to prioritize tasks and have the skill to multitask.

7. Medical terminology experience.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

SHC WVUHS Home Care

Cost Center:

392 SHC Access Administration