Insurance Manager

Company : Compassus

Position Summary

The Insurance Manager is responsible for modeling the Compassus values of Compassion, Integrity, Excellence, Teamwork, and Innovation and for promoting the Compassus philosophy, using the 6 Pillars of Success as the foundation. S / he is responsible for upholding the Code of Ethical Conduct and for promoting positive working relationships within the company, among all departments, and all external stakeholders. The Insurance Manager is responsible for leading and oversight of market insurance verification and authorization functions. S / he manages and trains a team of Insurance Coordinators through their day-to-day tasks. S / he processes, accurately and timely, insurance verification and authorization requests for home health care services for new or existing patients in accordance with their third-party payor policies while following all federal, state, and local regulations including Medicare and Medicaid guidelines.

Position Specific Responsibilities

• Manages a team that performs insurance verification and authorization functions.
• Conducts performance reviews, quarterly check-ins, and staff 1 : 1s to guide performance management and employee development and manage toward departmental goals, including quality and process improvement efforts.
• Manages market on-call schedules to ensure appropriate workload and ratio balance.
• Identifies, develops, and implements potential solutions to resolve problems and / or remove barriers that inhibit the department's ability to achieve performance goals.
• Maintains confidentiality and privacy of patient / family finances, records, health status, etc.
• Ensures compliance with applicable legal requirements, standards, policies and procedures including, but not limited to the Compliance Program : Code of Conduct, HIPAA and Documentation Standards.
• Maintains a thorough understanding of the revenue cycle which includes insurance requirements, billing, and associated correspondence, and is able to independently resolve issues.
• Provides effective communication to team members and other health care professionals while maintaining confidentiality.
• Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third-party payer requirements / online eligibility systems.
• Works closely with and supports team efforts to accomplish authorization / verification relative activities as directed.
• Documents payer and authorization information with the EMR system.
• Completes Payor Change process, as needed.
• Completes insurance verification on all new and existing patients requests and completes follow-up appropriately for authorization.
• Contacts insurance carriers to obtain and verify benefit coverage, policy limitations, and authorization / notification for patients.
• Reviews the insurance verification and completes the authorization process within established time frames. Accurately enters data into a software program.
• Scans and uploads appropriate documents to the patient chart and assists with completing patient profiles.
• Performs other duties as assigned.

Education and / or Experience

Skills

Physical Demands and Work Environment : The demands of this role necessitate a team member to effectively perform essential functions. Adaptations can be made to accommodate team members with disabilities. Regular standing, walking, and manual dexterity are fundamental, along with the ability to lift and move objects up to 25 pounds. Visual acuity requirements include close and distance vision, color and peripheral vision, depth perception, and the ability to adjust focus. This description provides a general overview and may vary by role and department, capturing the nuanced demands and conditions inherent to positions in our organization.

At Compassus, including all Compassus affiliates, diversity, equity, and inclusion are fundamental to our Pillars of Success. We are committed to creating a fair work environment where our team members feel welcomed, highly valued, and respected. As an equal opportunity employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

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