Insurance Authorization Specialist

Job Description

TARLANI Healthcare is dedicated to providing innovative, quality, and cost-effective home health services to patients in their homes involving families that require skilled nursing, rehabilitative, and support services.

Responsibilities

The position will entail the timely submission of authorization requests to assigned payers. Submission of requests will be completed using paper forms, printed documentation, fax, payer portals, or other means. Complete follow-up on requests to ensure timely turnaround and approval. Understand payer requirements to ensure approval is granted. Escalate problem accounts and ensure resolution. Regular contact with patients, insurance plans, physician offices, respiratory therapists, and other personnel is necessary.

Duties

Obtain authorization for patient care (initial authorization, reauthorization, follow-up on prior authorization, etc.)
Verify insurance eligibility; contact patients and departments with any negative outcomes
Assist billing with claims issues due to insurance authorization denials
Work closely with the clinical teams and referral sources regarding current and future authorization needs
Maintain progress/tracking reports on outstanding authorization to ensure timely request, receipt, and processing of authorization
Collect, review, discuss, and document demographic, insurance, and financial information with patients and payers
Follow approved guidelines and policies regarding routine patient and payer interactions
Negotiate payment reimbursement from a patient and third-party payers
Other duties as assigned