Delivers excellence in customer service which meets and exceeds customer expectations. Reviews and analyzes home care patient cases to effectively communicate with case management and insurance companies to justify continuation of Home care. Responsible for retrieving, recording and communicating authorization of care. Educates referral sources regarding qualifying criteria. Serves as a patient advocate and liaison between referral sources, physician office, vendors, case managers, insurance companies and patients to provide information and education pertinent to the care of the patient. Ensures authorization and optimal reimbursement by payor sources, case managers and private individuals.
Communicates with medical professional, vendors, insurance company personnel, and case managers to expedite patient authorization of requested services.
Complies with all department policies. Meets assigned quotas of monthly authorizations.
Identifies clinical needs of the patient and communicates with case management/insurance companies/Home Care staff.
Communicates with medical professional, vendors, insurance company personnel, and case managers to expedite patient authorization of requested services for initial authorization and documents the information into Horizon.
Prints daily RR note report and notifies clinical staff of expiring authorizations.
Obtains and maintains current knowledge of insurance coverage's (authorization process, documentation requested), and then informs the necessary people of required information.
Notifies central intake, scheduling, and clinical supervisors if unable to obtain authorization.
Maintains and updates database processes for obtaining authorization from specific payors.
Acts as a contact for new and existing accounts and maintains data related to original referral.
Follows up on service batch weekly.
Performs other duties as assigned, such as special assignments.
Graduate of accredited school of nursing: Licensed Practical Nurse, Therapist or Therapist Assistant.
Current Missouri LPN license and valid driver's license.
1 to 3 years insurance verification/authorization experience.
Good communication & clerical skills, word processing, knowledge of general computer skills including Windows.
Requires effective oral and written communication skills to communicate with staff, physicians patients and families, vendors, insurance and case management companies and other customers in a caring, courteous and professional manner.
Requires good decision making and problem solving skills.
SSM Health at Home –
SSM Health at Home offers highly skilled and experienced caregivers to help patients through difficult times. Services include extended at-home care, help managing pain or special support during terminal illnesses. SSM Health at Home is located in Illinois, Missouri and Oklahoma.
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your fa...mily and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same