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Insurance Validation Representative


Horizon Healthcare

Cost Center

3310 Horizon Health Services Operations

Supervisory Organization

Patient Account Services





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