Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale.Join us to start Caring. Connecting. Growing together.

The Home Health Authorization Specialist is primarily responsible for requesting authorizations from insurance companies on initial and continuation of services for skilled nursing, therapy services, home health aides, infusion therapy, as well as follow-up on the requests. Accountable for maintaining quality assurance on the home health intake process including but not limited to patient demographics, medical insurance verification, and authorization. Assures consistent, appropriate, and cost-effective care by actively managing patient/client needs based on payer's benefit requirements. Performs all functions in professional and ethical manner and collaborates with other members of the home health care team to ensure physician orders are submitted to the authorization department in a timely manner. Enters insurance authorization and eligibility information into current EMR. Actively participates in the Agency's on-call rotation in the home health Intake/Authorization role approximately once per month to include holidays.

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 9:00am - 6:00pm, with rotating on call shifts after 90 days of employment. It may be necessary, given the business need, to work occasional overtime or weekends. Our office is located at 19500 West Interstate 10 Building 2 Wellmed Corporate Office San Antionio TX 78257.

We offer 4 weeks of on-the-job training. The hours of the training will be aligned with your schedule.

Primary Responsibilities:

• Responsible for running authorization reports on a daily basis to ensure that authorizations for home health visits are being obtained in a timely manner per the time requirement in place.
• Verifies insurance eligibility and authorization of current and potential home health patients in an accurate and timely manner.
• Enters insurance authorization and eligibility information into current EMR
• Notifies supervisor and branch management regarding lack of payer coverage, other service non-coverage issues changes in authorization and eligibility.
• Willing and able to assist the intake home health team with entering new referrals, requesting information needed from physician office to complete referral.
• Ability to promote and maintain a positive attitude and encourage others to do the same.
• Responsible for checking email, HALO's, team messaging system and voicemail to respond to time-sensitive messages from customers, leadership, lower-level management.
• Supports and provides guidance to the home health departments across the enterprise pertaining to prior authorization.
• Conducts eligibility checks through all appropriate eligibility systems and uploads verification profile and uploads approved authorizations into electronic medical records (EMR).
• Into the home health electronic medical record (EMR)
• Performs quality assurance on all initial intake referrals upon submitting authorization request to assure there are no date entry errors by the intake specialist.
• Responsible for communication with clinic, patients, or insurance companies for coordination of benefits/policy/benefit changes as well as communicating with the branches for a potential discharge or discharge/readmit.
• Knowledgeable and able to navigate eligibility portals for patient information/authorization information: eCW ; naviHealth ; Avality ; EPRG ; Trucare ; Waystar; UHC.
• Request authorization from various insurance companies by faxing their authorization form, entering online submission, or by calling it in.
• Demonstrates self-direction to prioritize and accomplish job responsibilities
• Ability to multitask and change focus to accommodate meeting of team objectives and deadlines.
• Actively participates in the Agency's on-call rotation in the home health Intake/Authorization role approximately once per month to include holidays.
• Adheres and supports the company policies to include but not limited to: time reporting policy, attendance policy, code of conduct.
• Responsible for managing and completing their specific authorization tasks to ensure that all physician orders are reviewed for accuracy to minimize loss of authorization for visits.
• Perform general clerical duties in support of patient services. These include, but are not limited to, answering phones, copying, faxing, and reviewing incoming patient referral documentation for accuracy.
• Performs other job duties/responsibilities as assigned by direct supervisor.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED OR equivalent experience
• Must be 18 years of age or older
• 1+ years of experience in a medical physician office or home health back office administrative duties
• Efficient in 10 key and data entry
• Typing skills of a minimum speed of 40 wpm
• Ability to effectively read and follow written and verbal instructions in English
• Proficient in computer skills and knowledge of Microsoft Word/Excel processing software
• Background as a customer service representative in a medical/clinic setting, authorization specialist
• Ability to work our normal business hours of 9:00am - 6:00pm, Monday - Friday with rotating on call shifts after 90 days of employment. It may be necessary, given the business need, to work occasional overtime or weekends.

Preferred Qualifications:

• 1+ years of insurance verification experience
• Knowledge of medical terminology
• Bilingual fluency in English/Spanish
• Knowledge of general office procedures
• Intermediate knowledge in Microsoft Excel/Word
• Utilization Review or Prior Authorization experience
• Knowledge of the requirements for home health services
• Ability to operate computer terminal, printer fax, and copier machine

Soft Skills:

• Expresses verbal and written communication in a clear, positive, and cooperative manner
• Demonstrates personal responsibility with regard to attendance and punctuality
• Promotes Agency philosophy, mission statement, and administrative policies
• Maintains privacy and confidentiality with regard to all patient, staff and Agency information
• Promotes the Agency image by adhering to the Dress Code
• Follows the appropriate chain of command in all forms of communication
• Demonstrates flexibility, enthusiasm, and willingness to cooperate while working with others or in place of others as necessary

Physical and Work Environment:

• Ability to remain seated for prolonged periods and maintain concentration to task
• This position requires the ability to distinguish impressions of shape, size, distance, motion, color, and other characteristics of objects, through the eyes
• Major visual functions must include far sight acuity and near acuity
• Must have sufficient dexterity and visual acuity to operate office machine
• Performs duties in office environment during Agency operating hours
• Noise level may be moderately high
• Ability to work in a stressful environment. Positive environment is promoted for all Agency employees
• Occasional need to work extended hours
• Ability to maintain flexibility and adaptability to the work environment is critical

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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