Insurance Authorization Rep Lead - Home Care

Aurora Health Care - Milwaukee, WI3.7

Full-timeEstimated: $47,000 - $65,000 a year
EducationSkills
How You'll Make a Difference:
Maintains, confirms and secures referrals, authorization, or pre-certifications required for patients to receive physician or medical services. Verifies the accuracy and completeness of patient account information. Maintains database of payer authorization requirements. Assists the supervisor/manager in directing and coordinating the daily operations of the insurance verification and authorization functions as well as staffing oversight.

Acts as a resource to staff, which includes training/orienting, providing day-to-day work direction, and giving input on performance. Assigns, monitors, and reviews progress and accuracy of work, monitors productivity, maintains appropriate staffing levels, directs efforts and provides guidance on more complex issues.
Assists with human resource responsibilities, which may include interviewing and selection of new employees, staff development, providing performance feedback, resolution of employee concerns, and employee morale.
Assists in interpreting department policies and procedures, and advises and updates staff on procedural changes. Identifies performance improvement opportunities within the department and facilitates change. Monitors inventory levels and assists with managing department resources.
Oversees the daily activities and ensures department standards are met and department policies and procedures are followed. Identifies staffing needs and communicates those needs to department leadership.
Assists in the development and implementation of policies and procedures that guide and support service, assess and improve work group effectiveness and ensure competency in processes are met. Assists in educating staff of any changes pertinent to their roles.
Maintains quality assurance statistics and communicates results to department leadership.
Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for patients. Follows up with physician offices, financial counselors, patients and third-party payers to complete the pre-certification process. Notifies patient accounts staff/patients of insurance coverage lapses, and self-pay patient status.
Collaborates with internal departments to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.
Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third party payer requirements/on-line eligibility systems. Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans.

What it Will Take:
Licenses & Certifications

None Required.

Degrees

High School Graduate.

Required Functional Experience

Typically requires 3 years of experience in providing customer service that includes experiences in patient accounts, third- party payer plans, accounts receivable/collection processes, and medical clinic processes and workflow.

Knowledge, Skills & Abilities

Knowledge of third-party payers and pre-authorization requirements.

Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral / pre-certification / authorization processes.

Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, physician practice management, and electronic medical records systems.

Strong analytical, prioritization and organizational skills.

Ability to work independently with minimal supervision and to manage multiple priorities.

Exceptional communication and interpersonal skills with a high degree of diplomacy and tact.

Ability to effectively communicate with a variety of people under stressful circumstances.

Scheduled Hours:
Monday through Friday 8:00 am - 4:30pm. Occasional Saturdays 8:00 - 4:30pm.

Department:
Home Care DME Insurance Verification and Authorization

Location Address:
11333 W National Ave

Milwaukee, WI

53227-3111

Milwaukee

At Aurora Health Care:
At Aurora Health Care we pride ourselves on taking care of our people. And not just our patients—we mean you, too. We help each other live well. When you work at Aurora, you get the chance to work with a dedicated team that’s as passionate about the work as you are. Here, you’ll find limitless opportunities for ongoing learning, career advancement, competitive compensation and a stable work environment. But more than that, you have the opportunity to change lives—including your own.

Diversity and inclusion matters at Aurora. We celebrate our differences and nurture an environment where everyone feels included. We know that when we reflect the communities we serve, when we embrace differences and bring our whole selves to work every day, we are working as one to build a healthier tomorrow for everyone. Aurora supports a safe, healthy and drug-free work environment through criminal background checks and pre-employment drug testing. We maintain a smoke-free environment at all our locations. We are an equal opportunity employer.