Revenue Cycle Representative - Auth & Eligibility Job at ResMed (Chennai)

Revenue Cycle Representative - Auth & Eligibility

ResMed

Location:
India , Chennai

Category:
-

Contract Type:
Not provided

Salary:

Not provided

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Job Description:

The Home Health (HH) and Hospice (HOS) Authorization & Eligibility Specialist is responsible for verifying insurance coverage, determining patient eligibility, and securing timely authorizations for home health and hospice services. This role ensures accurate and compliant processing to support patient access to care while reducing reimbursement risk. The specialist works closely with clinical staff, referral sources, payers, and internal billing teams to provide exceptional service and efficient coordination.

Job Responsibility:

Verify insurance eligibility and benefits for all incoming home health and hospice referrals
Obtain prior authorizations from commercial, Medicare Advantage, Medicaid, and other payers as required
Review clinical documentation to ensure authorization requests meet payer requirements
Track authorization status, submit updates or re-auth requests, and prevent lapses in coverage
Document all eligibility and authorization details accurately within internal systems
Communicate authorization requirements and eligibility outcomes to intake, clinical teams, and billing
Collaborate with referral partners, including hospitals, physician offices, and case managers
Respond promptly to payer inquiries and requests for additional information
Serve as a subject matter expert for authorization rules and payer-specific policies
Ensure all processes adhere to payer regulations, CMS guidelines, and organizational policies
Maintain detailed, accurate records to support audits and minimize denials
Stay current on regulatory changes impacting home health and hospice eligibility or authorization requirements
Identify and address authorization-related issues that may affect reimbursement
Work with billing and revenue cycle teams to resolve authorization denials
Recommend process improvements to reduce avoidable denials

Requirements:

Minimum one year of progressive Home Health and/or Hospice billing experience preferred
Prior experience working with Medicare rules, regulations, billing codes (preferred)
Education equivalent to a High school diploma, college degree preferred
Ability to perform basic bookkeeping and compile statistics as needed
Ability to work independently
Must be organized and able to multitask
Strong written and verbal communication skills
Ability to type, operate computers and office equipment
Aptitude for learning computer systems
Maintain a professional demeanor, courteous and flexible at all times
Open to dynamic change and ability to thrive in such an environment
Willingness and ability to work effectively with members of other departments