Peoples Home Health, LLC
Position Summary
Is responsible for distributing admission information according to company policy; prioritizing phone calls; ensuring admission packets are available and appropriate; and interpreting insurance policy benefits to accurately reflect coverage amounts and client co‑pay (prior approval of insurance authorization). The Intake Specialist must be able to discuss and relay appropriate clinical information to obtain authorization for Home Care Services. They are also responsible for accurate data entry of referral data into HCMS. Abide by and demonstrate the company Mission, Vision, and Guiding Principles through both behavior and job performance on a day‑to‑day basis.
Essential Duties & Responsibilities
Accurately enter all demographic, financial and referral data into the computer systems to facilitate billing and scheduling in a timely manner.
Answer phones and appropriately route referral calls. Route calls based on clinical needs.
Prioritize phone calls for follow‑up (i.e., doctors, insurance company).
Back up to Intake Supervisor by preparing the client referral for clinical services, and loading new referral sources, in accordance with company policy, state and federal guidelines and private insurance contracts.
Monitor the web‑based program, “Allscripts”, for open referrals and respond as needed.
Assist with accepting physician orders, as needed.
Appropriately prioritize referrals so that the most urgent needs are met first. This includes consulting with CTM’s, schedulers, and referral sources for coordination of admission dates and times.
Calculate co‑pays and deductible amounts as per insurance reimbursement rates.
Complete all necessary documentation for initial authorization in accordance with the insurance company contracts.
Complete all requests for follow‑up authorizations as needed, notify staff of all authorizations received and visit limits, as well as need to discharge client due to denial for further authorization.
Participate in communications and resolution of problems with insurance interpretation. Identify insurance carriers and verify benefits and eligibility.
Collaborate with CTM/Case Manager on authorized visit to assure accurate utilization for patient needs.
Follow up with AE/Liaisons via text or email to assure notification of referrals received and documentation needed.
Answer text or calls on weekends and after hours for insurance questions of new referrals.
Act as backup to clinical staff and assist as necessary with copying, faxing, etc.
Demonstrate the ability to make customers feel satisfied and appreciated.
Maintain an understanding of the company’s scope of services.
Understand the infrastructure and how and where to transfer calls in the company.
Maintain a professional image.
Use appropriate phone etiquette.
Promote a customer‑friendly atmosphere for all visitors and ensure patient confidentiality at all times.
Participate in accreditation program.
Assist referral sources with finding placement for patients that company cannot accept due to insurance reasons.
Pass on all outstanding referrals and details to the nighttime/ weekend intake supervisor, via phone/email.
Maintain daily referral report and send out to assigned staff.
Perform other duties as assigned.
Licenses, Certifications and/or Registrations
Current Florida LPN license required.
Dependable transportation with valid driver’s license and auto insurance.
Education / Experience Graduate of an accredited LPN program. Minimum three (3) years of prior experience in a medical field or medical office setting is preferred. Knowledge of billing, insurance reimbursement, medical terminology, diagnosis coding preferred. Experience with troubleshooting computer errors, maintaining records, and organizing is preferred. Proficiency using Microsoft Word and Excel is required. Able to prioritize and manage time effectively and make independent decisions when necessary.
Working Conditions Office Environment. May be exposed to biological hazards.
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Essential Duties & Responsibilities
Accurately enter all demographic, financial and referral data into the computer systems to facilitate billing and scheduling in a timely manner.
Answer phones and appropriately route referral calls. Route calls based on clinical needs.
Prioritize phone calls for follow‑up (i.e., doctors, insurance company).
Back up to Intake Supervisor by preparing the client referral for clinical services, and loading new referral sources, in accordance with company policy, state and federal guidelines and private insurance contracts.
Monitor the web‑based program, “Allscripts”, for open referrals and respond as needed.
Assist with accepting physician orders, as needed.
Appropriately prioritize referrals so that the most urgent needs are met first. This includes consulting with CTM’s, schedulers, and referral sources for coordination of admission dates and times.
Calculate co‑pays and deductible amounts as per insurance reimbursement rates.
Complete all necessary documentation for initial authorization in accordance with the insurance company contracts.
Complete all requests for follow‑up authorizations as needed, notify staff of all authorizations received and visit limits, as well as need to discharge client due to denial for further authorization.
Participate in communications and resolution of problems with insurance interpretation. Identify insurance carriers and verify benefits and eligibility.
Collaborate with CTM/Case Manager on authorized visit to assure accurate utilization for patient needs.
Follow up with AE/Liaisons via text or email to assure notification of referrals received and documentation needed.
Answer text or calls on weekends and after hours for insurance questions of new referrals.
Act as backup to clinical staff and assist as necessary with copying, faxing, etc.
Demonstrate the ability to make customers feel satisfied and appreciated.
Maintain an understanding of the company’s scope of services.
Understand the infrastructure and how and where to transfer calls in the company.
Maintain a professional image.
Use appropriate phone etiquette.
Promote a customer‑friendly atmosphere for all visitors and ensure patient confidentiality at all times.
Participate in accreditation program.
Assist referral sources with finding placement for patients that company cannot accept due to insurance reasons.
Pass on all outstanding referrals and details to the nighttime/ weekend intake supervisor, via phone/email.
Maintain daily referral report and send out to assigned staff.
Perform other duties as assigned.
Licenses, Certifications and/or Registrations
Current Florida LPN license required.
Dependable transportation with valid driver’s license and auto insurance.
Education / Experience Graduate of an accredited LPN program. Minimum three (3) years of prior experience in a medical field or medical office setting is preferred. Knowledge of billing, insurance reimbursement, medical terminology, diagnosis coding preferred. Experience with troubleshooting computer errors, maintaining records, and organizing is preferred. Proficiency using Microsoft Word and Excel is required. Able to prioritize and manage time effectively and make independent decisions when necessary.
Working Conditions Office Environment. May be exposed to biological hazards.
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