Home Health and Hospice Authorization Representative

Job Description: This position is responsible to obtain insurance eligibility and benefits information and obtain required authorizations. Reviews all insurance eligibility responses and communicates with the physician's office and insurance companies as needed regarding these responses or to obtain correct information. Works with Utilization Review staff to ensure authorizations cover services needed. May also estimate cost of service and patient's responsibility. Refers patients with questionable insurance coverage to the Eligibility Counselors. May assist in mentoring new hires. The hiring manager is considering candidates with demonstrated experience utilizing Epic and other electronic medical record (EMR) systems, working within a clinical healthcare setting, and managing claims and appeals processes. Schedule - Monday - Friday 8:00am - 4:30 Job Essentials Obtains insurance eligibility and benefit information using various phone and on-line resources. Obtains appropriate authorizations and notifies insurance companies of patient arrival as needed. Works with Utilization Review staff and/or physicians' offices to assure eligibility and authorization requirements are completed within the required timeframe. Communicates with the appropriate nursing and/or billing staff when changes are made to the account that will affect the reimbursement. Makes appropriate corrections in the patient's record to ensure accuracy in order to prevent denials and/or problems with billing and reimbursement. Immediately refers 'at risk' admission to eligibility, i.e., out of network, underinsured, max benefits, etc. Works with insurance eligibility responses and other appropriate reports and works with physicians and patients as needed to resolve issues and prevent billing delays. Maintains a satisfactory level of performance and adherence to workload standards. Estimates cost of service using ICD-9 or CPT codes. Interprets 271 response, including insurance terminology, in online tool to determine patient responsibility. Performs calculations using insurance benefit information to accurately estimate patient responsibility. May lead and/or train new employees in account preparation and review functions. Minimum Qualifications Two years of customer service experience. Demonstrated good communications and computer skills. Preferred Qualifications Demonstrated knowledge of medical terminology. Experience in admitting, billing, collections, and/or insurance verification. Bi-Lingual Spanish speaking. Demonstrated knowledge of CPT/ICD-9 codes. Strong experience with EPIC and EMR Experience working in a clinical setting Experience with claims and appeals Interact with others requiring the employee to communicate information. Operate computers and other office equipment requiring the ability to move fingers and hands. See and read computer monitors and documents. Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment. Location: Home Services - Salt Lake City Work City: South Jordan Work State: Utah Scheduled Weekly Hours: 40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $18.85 - $25.61 We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits package here . By applying for a position with Intermountain, I acknowledge that I will comply with all applicable Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment. I further acknowledge that outside employment or activities may not interfere with job responsibilities or create a conflict of interest with Intermountain. Actual or reasonably perceived conflicts may be grounds for disqualification from consideration or, if hired, corrective action up to and including termination of employment. Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process. All positions subject to close without notice.