Intake and Authorization RN

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:

Innovive 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.