Medical Insurance Authorizations & Referrals Patient Liaison
- Job Title
- Medical Insurance Authorizations & Referrals Patient Liaison
- Job ID
- 27739004
- Location
- DeKalb, IL, 60115
- Other Location
- Description
-
1) The screening and accurate completion of referrals to ensure patients meet agency admission criteria and comply with state and federal regulations.
- Processes referrals for all programs (Traditional, Peds, and Infusion Therapy) from hospital sites, MD offices, utilizing standard work and determines whether patient qualifies for home care based on established guidelines.
- Verifies home health care benefits according to payor plans. Obtains authorizations for services as indicated.
- Ensures physicians initial home care orders are obtained.
- Identifies risk management situations and completes high risk referral process on all appropriate patients based on established guidelines.
- Interprets company services, admission criteria and medical policies to referral sources and individuals seeking information.
- Documents the initial plan of home health care and initiates interdisciplinary communication.
- Interviews patients/families in the hospital or SNF, to assess and evaluate patient for home care appropriateness.
- Works in conjunction with the care management staff to assist the patient/family in the initiation of home care services. Responds to inquiries regarding home care services.
- Works within established productivity guidelines for assigned site(s). Reports productivity to supervisor daily.
- Trains patient/families in using equipment (e.g. pump) at home.
- Acts as a resource to physicians, physician offices, patients and families, hospital and designated skilled nursing facility staff (i.e. care management, discharge planners, social workers, nursing) regarding types of services available and the criteria for home care, including Medicare guidelines.
- Provides education to the care team as requested on services that may enhance the transition of care for patients including DME, Hospice, Palliative Care, Pediatrics and Home Infusion Therapy.
- Maintains knowledge of Medicare, Medicaid and HMO procedures.
- Attends site based multidisciplinary meetings (e.g. readmissions, capture, discharge planning) that involve Advocate at Home patients.
- Assures appropriate follow-up to patient satisfaction issues relating to home care services.
- Provides courteous service to patients, families, staff, and physicians.
- Accountable for ensuring complete referral information is obtained for accurate and timely billing.
- Maintains knowledge of agency payers including Medicare, Medicaid and contracted commercial insurance reimbursement guidelines.
- Collaborates with insurance verification to insure optimal reimbursement.
- Assists in the development of policies and procedures to ensure compliance with current practice standards.
- Obtains Face-to-Face (F2F) encounter form for all Medicare, Medicaid and Medicaid pending patients during referral process or within the first 7 days.
- Educates physicians in the Face-to-Face process.
- Maintains competency by attending monthly training and interdisciplinary team meetings.
- Provides suggestions or improvements in current practices (i.e. process, documentation, etc.) to improve quality, productivity and customer satisfaction.
- Provides a positive attitude for Advocate at home through self-management.
- Provides input regarding performance and compliance to standards of peers.
- Adapts to changing business needs, conditions and work responsibilities.
- Partners with peers to ensure productivity levels are achieved.
- Follows standard operating procedures and guidelines during referral processing to insure consistent messaging and superior customer service is provided.
- Participates in precepting new hire training and orientation.
- Partners with peers and other product lines to provide complete and thorough patient hand-offs when appropriate.
- At least 2 years of experience with processing referrals from hospitals and MD offices.
- At least 2 years of experience in obtaining authorizations for medical services.
- At least 2 years of experience with Medicare, Medicaid and commercial insurance reimbursement guidelines.
- At least 2 years of customer services experience with patients, patient families, physicians, and medical facilities.
- High School Diploma or GED
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.
