Insurance Mgmt Specialist I

Location

Morristown, NJ | United States

Job description

1. Performs review of service requests for completeness of information, collection, and acquisition of structured clinical data from our Care Access Center (CAC).
2. Handles screening for precertification requests from Epic WQ.
3. Obtains timely authorization for home care and hospice services from select payers online, by telephone or fax per company requirements.
4. Acts as a liaison between the clinicians and the Utilization Review/Medical Management departments at insurance companies.
5. Enter pending authorizations into Epic.
6. Prepare updates on patient condition with appropriate recommendations to ensure authorizations.
7. Function as a liaison between external Case Managers/Insurance Companies and internal staff.
8. Notify internal staff when patient updates are required.
9. Request and /or submit clinical documentation for authorization/reauthorization in Epic.
10. Work with the Billing Department in obtaining retro authorizations with denials and appeals from insurance companies.
11. Performs other duties as needed.
12. Opportunity to work hybrid (2 days) after intro period 

1. High school diploma or GED.
2. College degree preferred.
3. Experience with obtaining authorizations, familiar with insurance verifications.
4. Epic experience a plus.

Job tags

Salary