Intake and Precertification Specialist – Home Health and Hospice

🔥 11 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Coordinate intake for new patient referrals, including receiving referral information, insurance verification, and scheduling initial assessments. • Serve as the primary contact for patients, families, referral sources, and healthcare professionals regarding referral and authorization status. • Obtain and document initial and ongoing authorization numbers using EPIC or other electronic systems. • Maintain accurate precertification, authorization, and referral communication documentation. • Communicate with insurance companies to obtain prior authorization and resolve authorization-related issues. • Monitor authorization status and certification deadlines, including proper sequencing of payors for billing. • Enter and maintain patient referral and insurance information in appropriate systems. • Coordinate initial assessment scheduling with clinical staff. • Apply CPT and HCPC coding knowledge to precertify and authorize home health/hospice referrals. • Assist with denial management, audits, and documentation requests. • Track referral activity and ensure timely processing to support admission and billing. • Communicate with internal departments regarding authorization status and referral progress. • Meet productivity, throughput, turnaround-time, and deadline expectations. • Provide exceptional customer service to patients, families, referral sources, and care teams.

🎯 Requirements

• High School Diploma or equivalent. • Two (2) years’ experience in insurance verification, authorization or healthcare intake. • Knowledge of CPT, ICD 10, HCPC, LMRPs, and similar coding/guidelines for post-acute care authorization. • Knowledge of third-party payor requirements, contracts, authorization and payment practices. • Knowledge of EPIC platform preferred, although others will be taken in consideration, if appropriate. • Medical terminology experience. • Ability to complete tasks consistently. • Ability to communicate effectively with the public and health care team in a courteous and professional manner. • Ability to prioritize tasks and multitask. • Ability to maintain accuracy, efficiency, timeliness, and attention to detail in a high-volume, deadline-driven environment.