Insurance Verification and Utilization Review Specialist
|Education:||Associates Degree - Business or Secretarial Science|
|Experience:||Three to Four Years|
This position will analyze patient insurances and verify eligibility and benefits and determine the primary payor for home health, mental health and hospice services. Obtain prior authorization for payment of services when required from third party payors or managed care companies and determine which payers will require ongoing authorizations, collaborating with Agency staff, patients, family members, facilities and physician. Responsible for utilization management of services, verifying authorization of services throughout patient’s care. Coordination of payor changes as well as claims denial management.
Medical Terminology and computer coursework or equivalent required. Working knowledge of medical terminology and healthcare insurance authorization processing. Computer skills including word processing and data entry required. Experience in dealing with internal and external customers in a fast-paced multi-task environment required.