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DATE ADDED: Thu 27/09/2018

Prior Authorization Coordinator

Somerville, USA
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COMPANY: NIZHONI HEALTH

Job Description

WHO WE ARE:

Nizhoni Health provides an innovative team approach to home health services. We enable our patients with the most acute needs—those who experience chronic illnesses, psychiatric issues, or lengthy recovery processes to have more productive lives within their own home settings. By coordinating care with our patients’ existing medical providers, we can improve outcomes, reduce readmission, and control costs. As a leader in Home Care, our agency connects with over 3000 patients throughout Massachusetts.

Whether it is a clinical or administrative position at this innovative organization we all share the same value; provide superior service across the spectrum of care.

POSITION SUMMARY:

Ensure accurate and timely completion of client prior authorization and/or change of therapy paperwork. Sends all forms to prescriber and appointed facility contacts for completion. Follows up on all claims requiring prior authorization within 4-5 business days. Responsible for maintaining an accurate book of business in Excel to ensure continuous transparency to the team and its leadership. Compares system report of unbilled claims requiring prior approval to excel tracking spreadsheet to ensure any claim requiring prior authorization is being followed up on. Assists Billing Department with resolving unbilled claims at each month end close.

 

RESPONSIBILITIES:

  1. Obtain prior authorization or pre-certification of services to be rendered as required by MassHealth
  2. Answer incoming telephone calls from front-line nursing staff and their clinical managers
  3. Complete and manage all paperwork or supportive documentation required for accurate billing
  4. Re-verify patient eligibility, monitor insurance lifetime caps and prior authorization periods
  5. Resolve patient / payor issues in a timely manner
  6. Participate in Departmental, Clinical and Company meetings as requested
  7. Participate in required training including, but not limited to in-services and educational programs
  8. Ensure transparency of work status to PA team leadership and recognize the need for escalations when warranted
  9. Coordinate relevant communication between business and clinical operations via email
  10. Understand and interpret new policies issued by MassHealth that impact Prior Authorizations
  11. Performs other activities and duties as deemed necessary, including assisting in key operational initiatives

COMPETENCIES:

  • Strong communication skills (verbal and written)
  • Strong critical thinking and problem solving skills
  • Excellent organizational skills with an attention to detail
  • Strong communication skills (verbal and written)
  • Ability to function in a fast-paced and dynamic work environment
  • Willingness to foster a cross-functional team environment

REQUIRED QUALIFICATIONS:

1. Associate’s degree or equivalent in related job experience

2. Minimum of one (1) year experience in a business setting, healthcare preferred

3. Proficiency in Microsoft Excel and Outlook

Preferred Education and Experience

  • Experience with the HealthWyse electronic medical record solution;
  • Experience with MassHealth authorization process (LTSS)

 

PHYSICAL DEMANDS AND WORK ENVIRONMENT:

This position reflects a normal office environment:

  • Continually required to sit

Continually required to use hands and fingers. 

 

Company Description
Nizhoni Health provides an innovative team approach to home health services. We enable our patients with the most acute needs—those who experience chronic illnesses, psychiatric issues, or lengthy recovery processes to have more productive lives within their own home settings. By coordinating care with our patients’ existing medical providers, we can improve outcomes, reduce readmission, and control costs. As a leader in Home Care, our agency connects with over 3000 patients throughout Massachusetts.


Role: Prior Authorization Coordinator
Job Type:
Location: Somerville,

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