Eligibility & Authorization Specialist

Eligibility & Authorization Specialist 

Masonicare Home Health & Hospice - Wallingford, CT

Day Shift / 40hrs/wk

Obtains insurance information for Home Health and Hospice admissions, as well as ongoing pay plan management as assigned.

Essential Duties and Responsibilities:

1. Obtains accurate information from necessary parties pertaining to MHHH patient insurance verification, authorization, and eligibility. Queries payer eligibility databases, conducts research, and utilizes alternative available means to complete patient insurance verification.

2. Conducts Medicare HETS review for hospice and homecare patients, Medicaid EDS system query for patient eligibility and benefits. Contacts commercial payers to verify benefits for homecare and hospice patients. Conducts periodic review of patient’s eligibility upon request.  Ensures evidence of coverage is saved in Netsmart.

3. Obtains authorizations for services from assigned insurances.  Ensures timely receipt of authorizations both from the clinicians and insurance companies. Provides branch with required information regarding authorization maintenance including pending and denied services. Advises branch on appeal processes.

4. Conducts accurate data entry and maintains tracking system to identify discrepancies and overdue requests. Initiates appropriate and timely follow-up to mitigate preventable issues, and proactively communicates with branches as per policies. Responsible for accurate responses to billing inquiries in a timely manner not to exceed 5 business days.

5. Communicates effectively and tactfully, while exhibiting excellent customer service to both internal and external stakeholders. Upholds a collaborative and team-focused environment to provide excellent care to MHHH clients. 

6. Perform other duties as required.

Minimum Qualifications:  

Education:  High School Diploma or Equivalency

Experience:  Healthcare billing or insurance experience required. 

Maintains current Connecticut Driver’s License and auto insurance. Possess reliable transportation (Exception: Employee who utilizes public transportation-Supervisory approval required).