At Southcoast Visiting Nurse Association, Inc., we acknowledge that our employees are what makes us great!

FOUR YEARS IN A ROW, Newsweek named Charlton Memorial, St. Luke’s, and Tobey among the Best Hospitals in the World! Join our Team and find out why!

We are searching for an Insurance Authorization Specialist to perform a wide variety of duties to secure optimal revenue for all services performed at Southcoast VNA. Duties consist of entering orders, notifying patients of their potential liability and collecting payment electronically. Initiate contact with patients, physicians and third-party payers to obtain pre-certification and authorization for all homecare services. Determine the appropriate supporting clinical documentation to share with third party payers to validate medical need for services to be rendered. Work as a liaison between third party payers and providers to coordinate peer-to-peer discussions to authorize high dollar services. Use critical thinking skills to ensure HCPCS codes are documented and authorized for appropriate services. Partner with clinicians to obtain appropriate documentation to support ongoing medical necessity required by third party payers. Navigate multiple payer portals to determine requirements for authorization and submit electronic requests.

• Hours: 40hrs
• Shift: Day shift; 7:00am-4:00pm
• Location: Hybrid/ mostly remote. Southcoast Business Center – Fairhaven, MA

Education and/or Experience Requirements:

• Associate degree in a related field or equivalent combination of education and home health experience is required.
• Advanced understanding of Medical Terminology is required.
• Minimum of 5 to 7 years clinical experience in community healthcare and/or healthcare revenue cycle activities is required
• Coding experience is preferred, and knowledge of general accounting principles is required.
• Working knowledge of medical insurance for certified homecare is required.
• Proven exceptional customer service skills is a must.
• Must have ability to communicate with physicians, patients and third-party payers.
• Proficient with navigating multiple payer portals and web-based tools.
• Must be organized, detail-oriented and able to function independently in a fast-paced environment while managing multiple priorities.
• Requires a working knowledge of various computer applications Epic, MS Office and Electronic Fax.

Must be fully vaccinated against seasonal Influenza and COVID 19 and provide required vaccination documentation, unless approved for an exemption or deferral by Southcoast prior to starting employment.

Southcoast Visiting Nurse Association (VNA) has a long history of serving people in our community by helping patients of all ages recover or live well with illness or injury. We provide compassionate and personalized care in comfort and privacy of the home to more than 9,000 patients each year.

Southcoast Health is a community healthcare system with multiple access points, offering an integrated continuum of health services throughout Southeastern Massachusetts and Rhode Island. By uniting a single purpose and building an integrated system of services and resources, we have become one of the largest and fastest-growing health systems in Massachusetts.

Together We Are More.

• With more than 7,500 employees, Southcoast Health is the largest employer in Southeastern Mass., and the 18th largest employer in the Commonwealth, according to the Boston Business Journal.
• We strive for a culture of health and well-being that recognizes, respects, and celebrates the rich diversity of one another and the communities we serve.

We are committed to providing our employees in Massachusetts and Rhode Island with optimal benefits that promote a healthy work/life balance and add value to our employees’ lives.

• Generous Earned Time Off Package**
• Health, Dental and Vision Insurance*
• Tuition Assistance**
• Short Term and Long Term Disability Insurance*
• Life & AD&D insurance*
• Flexible Spending Accounts*
• 403B Retirement Plan with match
• HealthQuest Wellness Program
• Employee Assistance Program
• Employee Discount Program
• Career Development Opportunities
• Diversity, Equity, and Inclusion Council

Are you ready to make a difference in your community? Join us as we strive to be More than Medicine.

Southcoast Health is an Equal Opportunity Employer