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Insurance Validation Representative


Company

Horizon Healthcare

Cost Center

3310 Horizon Health Services Operations

Supervisory Organization

Patient Account Services

Grade

G07

Summary

PURPOSE:

To perform all duties related to authorization and reauthorization of patient services to support the Horizon Healthcare Services operation.

PRIMARY FUNCTIONS - JOB DUTIES: The percentage of time spent performing primary functions is 98%. Qualified individuals must have the ability--with or without reasonable accommodation--to perform the following duties:

  • Analyzes authorizations for content and dates, understanding the responsibility of the nursing agency.

  • Initiates initial authorization, re-authorizations, insurer referrals and all necessary clinical information and submits to insurer for auth.
  • Contacts payers in a timely manner to obtain authorizations and/or reauthorizations for Horizon services using established guidelines and professional communication skills.

  • Corresponds with billing-collections staff when more nursing visits may need authorized.  Communicates with assigned external agency liaisons when new/updated authorizations are obtained for their patients.

  • Enters patient authorization information into CPR & RN spreadsheet timely.

  • Takes care of red/blue team filing as directed.

  • Prioritizes work according to established deadlines.

  • Demonstrates understanding and knowledge of usage of all electronic validation/authorization tools.

  • Ensures authorization information entered into computer system is complete and accurate.

  • Accurately and completed enters patient authorization information and records dates on calendars for follow up and continuation of case managed patients

  • Generates reports from computer system as requested.

  • Demonstrates good knowledge of Microsoft Excel/Microsoft Word, using them effectively when necessary.

SECONDARY FUNCTIONS - JOB DUTIES: The percentage of time spent performing secondary functions is 2%.  The following duties are considered secondary to the primary duties listed above:

  • Perform all other reasonably-related duties of an equal or lower nature as may be directed in the sole discretion of management.

BURLE Full Time Posted on 03/10/2020