JOB TITLE: Eligibility & Authorization Specialist

DEPARTMENT: Revenue Cycle Management

DIVISION: Gulfside Healthcare Services

REPORTS TO: Revenue Cycle Manager

Hybrid schedule available.

M-F 8am-5pm LOCATION: 2061 Collier Parkway Land O' Lakes, FL 34639

POSITION SUMMARY:

Reporting to the Revenue Cycle Manager, the Eligibility & Authorization Specialist is responsible for the review and processing of nursing home financial forms, DCF notifications, verification and authorization.

EDUCATION AND QUALIFICATIONS:

High School Diploma/GED required, Associate’s Degree preferred.

Knowledge of third party and governmental payer requirements in order to obtain authorization.

Knowledge of Florida Medicaid requirements and processes.

Competency in using all industry based software related to job responsibilities (Waystar, Ability, Availity, Medicaid, et al)

Able to deal tactfully with patients, family members, referral sources and payers.

Knowledge of Microsoft Excel.

Knowledge of governmental regulations and billing guidelines.

ESSENTIAL JOB RESPONSIBILITIES:

Completes insurance verification and regulatory requirements for referred patients for hospice, home health and palliative care. Re-verifies on admission and completes payor setup in chart.

Completes hospice, home health and palliative care authorization requests on admitted patients and updates the electronic health record timely.

Documents new, pending and re-authorization requests in EHR. Coordinates with primary care physician offices for HMO plans.

File notice of election paperwork to Department of Children & Families for Medicaid patients.

Communicate daily with nursing homes and complete the nursing home reimbursement form upon admission.

Protects the confidentiality of patient and organization information through effective controls.

The incumbents may be requested to perform job-related tasks other than those stated in this description.

Flexible work from home options available.