Provide a high level of individual patient management that encompasses comprehensive insurance
verification, authorization, adherence to contract guidelines and negotiation of profitable rates with noncontract
payers. Maintain a level of accountability and consistency with cases.
Verify member eligibility and benefits with health insurance companies
Obtain all necessary medical records from Aveanna Locations and submit the information to the health
plan Case Manager to initiate the authorization process for nursing services and obtain
authorization or denial of services.
Seek clarification on benefits not clearly stated in benefit plan with lead representative or
Coordinate with member families and Aveanna Locations to ensure maximum benefits are available to
Negotiate rates for home health services when no contract applies
Maintain open communications with the Aveanna Locations on the status of obtaining authorization for
home health services.
Maintain open communications with the health plan case manager
Build and maintain payor relationships
Identify and adhere to payor specific requirements
Setup new patients in the Aveanna billing system
Communicate to Aveanna Locations the outcome of the request for authorization for services and
Coordinate with Aveanna’s Third Party Liability team to manage coordination of benefits
Provide assistance to AR department as needed to help with high dollar claims issues.
College Degree or equivalent experience
Minimum five (5) year prior Home Health Care experience
Minimum five (5) year prior experience in verifying eligibility and benefits for Home Health Services
Excellent oral and written communication skills
Ability to organize and prioritize responsibilities
Experience in Excel and Microsoft Word
Excellent interpersonal skills
Must demonstrate a positive attitude in a team environment
1. Must be able to perform movements that regularly require repetitive use of the wrist(s), hand(s) and
or finger(s) approximately 80-90% of the workday
2. Finger dexterity to perform typing, picking up small objects, etc. approximately 80-90% of workday.
3. Must be able to verbally communicate instructions or other information as required approximately
80-90% of workday.
4. Must have adequate visual abilities to prepare, inspect documents or operate office machinery
approximately 100% of workday.
5. Must be able to exert physical strength and occasionally lift up to 25 pounds and/or frequently up to
6. Must be able to hear average or normal tone conversations and understand/interpret noises or
7. Must be able to safely and properly drive vehicles.
8. Must be able to bend, turn/twist, kneel, squat 30-40% of each workday.
Requisition ID: R0008853