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Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.

LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

LV HOME CARE AND HOSPICE

INSURANCE VERIFICATION AND AUTHORIZATION REPRESENTATIVE - HOME HEALTH FULL TIME DAYS

Summary
Obtains and monitors insurance authorization for home health and hospice patients.

Job Duties

• Obtains authorization for all services based on insurance to ensure database integrity and facilitate claims processing.
• Documents patient authorization requirements, deductibles, co-payments, and coinsurance responsibilities. Completes accurate and complete insurance information into case communication notes for clinicians.
• Coordinates appeal processes for denied payment due to authorization or other insurance complications.
• Writes and submits appeals with substantiating documentation within deadline restrictions.
• Follows computer system, department operational procedures, and training guidelines to obtain accurate insurance information.
• Functions as a resource regarding insurance verification and authorization issues.

Minimum Qualifications

• High School Diploma/GED
• Demonstrated flexibility and effective problem solving in accommodating and meeting customer needs.
• Excellent computer skills.

Preferred Qualifications

• Associate’s Degree
• Less than 1 year Health care office setting or
• Less than 1 year Authorization

Physical Demands
Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.

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Lehigh Valley Health Network does not accept unsolicited agency resumes. Agencies should not forward resumes to our job aliases, our employees or any other organization location. Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes.