Insurance Authorization Specialist - KidsCare Home Health

Overview

Pursue your passion and fulfill your purpose at KidsCare! KidsCare Home Health is a multi-award-winning organization who was most recently recognized as a 2024  U.S. Top Workplace. As an award-winning organization, we are looking for dedicated professionals who will embrace the KidsCare core values. At KidsCare we desire to work with individuals who embody the values of the organization which together create our C.A.R.E. culture. In return we offer a full benefits package to include health, dental, and vision insurance, paid time off, 401K, tuition reimbursement, and a hybrid or blended work arrangement (providing balance between in office and work from home).

Responsibilities

The Insurance Authorization Specialist works with multiple payer sources and obtains insurance authorization for physician ordered services. The position is also responsible for monitoring and recertifying patient insurance authorization prior to the current expiration date.

Essential Duties and Responsibilities

• Maintain authorization workflows and the authorization roster.
• Contact payer source for outstanding authorizations.
• Process original authorization as well as ensure timely review and updating for reauthorization.
• Complete scan and send TP2 forms and all other reauthorization documentation to the ordering physician and payer source. Provide timely follow up.
• Schedule TRC evaluations with patient families and Clinical Manager.
• Process payer changes timely.
• Ensure timely processing of discharges in the organization’s healthcare software system.
• Assist with the processing of incoming referrals as needed.
• Comply with all company policies, practices, and procedures.
• Other duties as assigned.

Qualifications

Education and Work Experience

• High school diploma or general education degree (GED).
• Minimum of one (1) year of experience.

Other Qualifications and Skills

• Bilingual English/Spanish with an ability to read, write and speak both languages fluently.
• Ability to carry out detailed but involved written instructions, able to problem solve with few variables.
• Ability to communicate clearly, written and verbally.
• Adaptability and self-motivated.
• Microsoft Office and database activity.
• Handle multiple tasks simultaneously.

Physical Demands/Working Environment 

• While performing the duties of this job, the employee is regularly required to, stand, sit; talk, hear, and use hands and fingers to operate a computer and telephone keyboard.
• Ability to sit at a computer for an extended period.
• Light to moderate physical activity and lifting is required.
• Specific vision abilities required by this job include close vision requirements.
• Moderate noise (i.e., business office with computers, phone, and printers, light traffic 

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

About KidsCare

Established in 2003, we are a pediatric home health agency serving children with special needs across the country. Our focus is on nursing, speech, physical, and occupational therapy as well as providing case management for children up to 18 years of age.  Founded upon the principle that patient care/therapy is most effective when it is one-on-one, set in a familiar environment and includes family member and caregiver involvement, the organization has grown from its original roots in Dallas Texas to a multi-state operation.  Regardless of this growth, however, our original commitment of providing quality health care to every child and family serviced as never changed.