Intake and Precertification Specialist, Home Health and Hospice

🔥 27 minutes 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, referral, and communication documentation • Communicate with insurance companies to obtain prior authorization and resolve related issues • Monitor authorization status, certifications, recertifications, and payer sequencing for billing • Enter and maintain patient referral and insurance information in appropriate systems • Coordinate initial assessment scheduling with clinical staff • Maintain current knowledge of CPT and HCPCS coding to precertify/authorize home health and hospice referrals • Assist with denial management, audits, and documentation requests • Track referral activity and ensure timely processing to support admission and billing • Communicate authorization status and referral progress to internal departments • Meet productivity, throughput, turnaround-time, and deadline expectations in a high-volume referral environment • 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 • Knowledge of third-party payor requirements, contracts, authorization and payment practices • Knowledge of EPIC platform preferred; experience with other appropriate systems considered • Medical terminology experience • Able to complete tasks consistently • Able to effectively communicate with the public and health care team in a courteous and professional manner • Able to prioritize tasks and multitask • Scheduled weekly hours: 40