Eligibility Coordinator (Full Time)

Verifies insurance coverage/benefits for all hospice & palliative care referrals. Work with Insurance Case Managers to maximize services for patient and appropriate reimbursement for agency.
Enter all insurance information into EMR in proper filing order. Completing pertinent insurance verification and notes. Include patient liability and insurance specific services as applicable for nursing home and physician services.
Obtains the initial authorization for services as well as ongoing authorizations utilizing clinical documentation to support services rendered. Enters obtained authorization information in EMR.
Monitors and maintains in EMR, authorization letters from payers to ensure accuracy based on the services rendered.
Review and update EMR daily from status change emails, admission and discharge reports for changes that affect billing compliance. Obtain updated insurance authorization as applicable.
Review Medicare admissions for compliance and prepare NOE spreadsheet for entry. Assist in NOE entry when needed. Maintain NOE entry within 5-day for compliance with Medicare regulation and report any non compliantaccounts to department director and billing staff.
Exercises knowledge of Hospice regulations, and standards relative to, TennCare/MCOs, Medicare and various other Payers.
Run IPU NP visit report and review visit note for MD addendum/attestation and enter MD charge as appropriate. Complete process throughout the month to not delay month end billing.
Assist in monthly compliance audits as requested by director. (MSPQ & Live Discharge report)
Assists with collection efforts as it relates to authorized services, dates, and individual hospice & palliative care benefits. Works cooperatively with clinical and financial staff to achieve goals.
Trouble shoots with internal clinical staff to research specific patient insurance issues.
Other duties may also be assigned.


QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.



EDUCATION and/or EXPERIENCE

Associate's degree (A.A.) or equivalent from two-year college or technical school; minimum three years related experience and/or training; or equivalent combination of education and experience. Proficient Microsoft Office.



CERTIFICATES, LICENSES, REGISTRATIONS

If required to drive to carry out the duties of this position: current driver's license and automobile insurance as required by Tennessee state law.



PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.



While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee frequently is required to use hands to finger, handle, or feel. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, and color vision.



WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.








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