Ultilization / Authorizations Specialist

Irvine, CA 92614 | Temp-to-Hire

Job ID: [SA] Home Infusion Industry: Healthcare Pay Rate: $20-$28

Home Infusion Authorizations Specialist

We are seeking an Home Infusion Authorizations Specialist who has the ability to work in a deadline driven, fast paced environment, and understands the urgency of these authorizations. You MUST have a minimum of 5 Years experience and know how to convert J Code unit values.

We are a thriving and stable organization offering a fun and supportive atmosphere, where your skills as an Authorization Specialist will be valued! Our department focuses on HCPCS, ICD-10 codes for DME, Physical Therapy, Respiratory, or Oncology including IV Therapies(injectable). 

The Home Infusion Authorizations Specialist will process and request authorizations for IV Therapies.

Responsibilities:

  • Convert J code unit values
  • Solid working knowledge with HCPC, ICD-10 & CPT codes.
  • Working applications of HCPC codes, Medications and familiar with A, J, S, and T Codes. (home health, hospice, DME, and infusion)
  • Submit online or paper authorizations requests to Medical payers such as Blue Cross, Blue Shield, Aetna, and other PPO & HMO payers. (We work with over 60 contracts).
  • Knowledge of medical billing systems and clearing houses with special emphasis on home health, hospice, and infusion
  • Knowledge of Shared Risk the premiums and losses of each member of a group of policyholders are allocated within the group based on a predetermined formula
  • Comply with Home Health Network Codes of Safe Practice, safety policies and emergency procedures
  • Comply with HIPAA guidelines
  • Possess good computer skills, Microsoft Word, Excel, and Outlook
  • 5 years of experience with billing systems and clearing houses with special emphasis on home health, hospice, and infusion
  • High school diploma or equivalent
  • Working experience with HCPCS codes with a focus on J, A, S, and T codes
  • Schedule: Mon – Fri as early as 8:30 AM – 5:30 and as late as 10 AM to 7PM, with one floating Saturday every 5 weeks from 9-5:30 PM.

We will consider for employment all qualified Applicants, including those with Criminal Histories, in a manner consistent with the requirements of applicable state and local laws, including the California Fair Employment and Housing Act (FEHA).

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