Insurance Authorization Coordinator

The Pennant Group

2d

About The Position

Insurance Authorization Coordinator- Home Health and Hospice Join Pennant’s dynamic insurance authorization team as the Insurance Authorization Coordinator! We are looking for an exceptional team player to orchestrate the crucial function of securing timely and accurate insurance authorizations for our patients. Your expertise will be key to ensuring uninterrupted care and optimizing our financial health. About the Role You will be responsible for all aspects of payer authorization. This role demands deep knowledge of payer requirements, strong ownership skills, and meticulous attention to detail to ensure every patient's services are appropriately covered from admission through discharge.

Requirements

• Minimum of 3 years of dedicated experience in insurance verification and authorization, specifically within Home Health or Hospice.
• Expert knowledge of Medicare, Medicaid, and commercial insurance authorization processes and documentation requirements for episodic and per diem payments.
• Proficiency in using electronic medical record (EMR) systems and authorization tracking software.
• Superior analytical and organizational skills with an unwavering attention to detail.
• Exceptional ability to navigate complex payer portals and communication channels.
• Excellent interpersonal skills for effective collaboration with clinical and scheduling staff.
• Proven ability to lead a team in a high-volume, deadline-driven environment.
• Strong commitment to regulatory compliance and ethical billing practices.

Nice To Haves

• Associate's or Bachelor's degree in Business, Finance, Healthcare Administration, or a related field.
• Experience with utilization review and appeals processes.

Responsibilities

• Initial Authorization: Oversee the timely and accurate submission and tracking of all initial insurance authorization requests for home health and hospice patients.
• Collaboration and Communication: Work closely and effectively with the scheduling teams to coordinate start of care and ensure clinical services are only delivered after authorization is confirmed.
• 485 and Add-On Authorization: Direct the process for obtaining authorization following the 485 (Plan of Care) submission and managing all add-on insurance authorizations when required for changes in the patient's plan of care (e.g., increased visits, new services).
• Ongoing Eligibility Management: Establish and monitor the process for the team to re-verify eligibility on the 1st and 5th of each month for all active patients to proactively identify and resolve any changes in insurance status.
• Payer Relations: Serve as the escalation point for complex authorization denials or issues, communicating directly with various insurance carriers.
• Compliance and Reporting: Ensure all authorization processes are compliant with payer contracts and regulatory standards. Generate reports on authorization status, denial rates, and turnaround times.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree