Intake and Authorization RN
Company: Innovive Health
Location: Colorado Springs
Posted on: October 23, 2024
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Job Description:
Become an Innoviver!At Innovive Health, our mission is to
provide best-in-class home healthcare services to patients with
chronic behavioral health issues and complex medical needs. Our
team is made up of skilled caregivers, nurses, and operations staff
who collaborate to create innovative technology and data-driven
solutions while ensuring the best outcomes for our patients. If you
enjoy working one-on-one with patients outside of a clinical
setting, Innovive Health has the opportunity you're looking for.
Innovive Health offers work-life balance, a competitive benefits
package, and a competitive salary based on experience. If this
sounds like the type of work you're looking for, apply
today!POSITION SUMMARY:As an Intake & Authorization Nurse at
Innovive Health, you will oversee the inbound referral and
authorization process from first contact to admission.
Responsibilities range from collecting information from referral
sources, processing documentation in a timely and effective manner,
verifying insurance, confirming patient eligibility, obtaining
authorizations, Start of Care and Resumption of Care coordination,
patient regulatory documentation, and accurate EMR data entry and
working with the Colorado single points of entry to ensure patient
enrollment for long term services. Incumbent will also drive
effective and timely communication internally with multiple
operation and clinical teams, and externally with our referral
sources to ensure a delightful experience. Further responsibility
will lie in ensuring Intake is meeting current state guidelines,
including but not limited to F2F documentation, timeliness of care,
and other regulations as required and escalating any issues to the
Clinical Director and VP of Strategy.What you'll do:--- Coordinates
new referrals, resumptions of care and re-admissions for home
health services.--- Promotes, drives, and ensures adherence to a
high level of communication between referral sources and internal
stakeholders.--- Ensures appropriate, timely notification to
referral sources regarding status.--- Obtains all necessary
documents including but not limited to; patient medical history,
immunizations, medication list and face-to-face documentation.---
Reviews incoming paperwork for compliance with state, federal and
payor compliance.--- Ensures that providers and health systems in
the geographic coverage area are in Salesforce to support full
referral documentation in the CRM--- Enters and uploads
documentation into company EMR, HealthWyse ("HW")--- Runs
eligibility for new referrals and coordinates issues with the
Senior Clinical Documentation Specialist--- Enters new providers
into the system via the MD Request line in Healthwyse and
Salesforce--- Confirm both PECOS and Medicaid program registration
of new providers at time of referral.--- Reconcile new providers
that require supervision per regulatory standards to their
supervising physician in EMR--- Run the Physician PECOS list once a
week--- Collects appropriate demographic information, checks
insurance eligibility, and collects required documentation to
ensure regulatory compliance with Medicare and Medicaid--- Obtains
prior authorization or pre-certification of home health services to
be rendered as required by each individual payor and single access
point in Colorado; completes and manage all paperwork or supportive
documentation required for performing effective billing.--- Serves
as an internal resource and consultant to Clinical as well as the
Authorization Department, about medical necessity documentation,
reimbursement, clinical resource utilization, and care coordination
issues.--- Assists the authorization department staff with any
clinical related questions, especially when patient's decisions
have been placed on deferment, review assigned case and assist the
authorization staff with formulating appropriate response to
HealthFirst designated PAR entity.--- Reviews assigned denied
decisions and reports to Clinical Director and VP of Strategy with
recommendations toward future improvement process.--- Adheres to
HIPAA laws and maintains patient confidentiality at all times.---
Participates in appropriate continuing education, committees, and
meetings as required.--- At initial authorization and ongoing
reauthorization processes, makes sure the documentation of
clinicians supports the medical necessity as outlined by CMS and is
consistent with current insurance guidelines. Escalates concerns to
Clinical Director for review.--- Re-verify patient eligibility,
monitor insurance lifetime caps and prior authorization periods.---
Collaborates with Senior Documentation Specialist to resolve
patient/payor issues in a timely manner.--- Performs other duties
as assigned.What you need:--- Graduate of an Accredited school of
Nursing with a Bachelor of Science in Nursing--- Currently licensed
as an RN in the state of Colorado with no restrictions--- 3+ years
of clinical experience--- 1+ year of experience in a home health or
post-acute setting--- 1+ year related experience (intake, referral
processes, authorization, etc.)Preferred Education & Experience:---
3+ years of related experience preferredWe believe our employees
are our greatest asset! What we offer:--- Competitive salary based
on experience--- Comprehensive benefits package includes medical,
dental, vision, disability, and life insurance--- 24 days of paid
time off--- Paid Company Holidays--- 401k with company match---
Dayforce Wallet - voluntary benefit that gives you access to earned
pay--- Wellness program--- Tuition reimbursement--- Online CEU
credits--- Excellent career growth opportunitiesInnovive Health
provides equal employment opportunities to all employees and
applicants for employment and prohibits discrimination and
harassment of any type without regard to race, color, religion,
age, sex, national origin, disability status, genetics, protected
veteran status, sexual orientation, gender identity or expression,
or any other characteristic protected by federal, state or local
laws.
Keywords: Innovive Health, Pueblo , Intake and Authorization RN, Healthcare , Colorado Springs, Colorado
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