Intake and Eligibility Coordinator

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Full Time Clerical Niles, IL, US

2 days ago Requisition

Salary Range: $20.00 To $21.00 Hourly

This role is primarily responsible for the meticulous management and verification of client insurance eligibility and authorizations. By proactively monitoring, renewing, and tracking all insurance-related data, the Coordinator ensures seamless, uninterrupted client care and enables the agency to bill accurately for services rendered. This position requires a high level of detail orientation, proactive communication, and expert navigation of various insurance portals.

Furthermore, this role provides essential support and serves as a key resource for many of the departments within Home Services.

Responsibilities:

1. Eligibility Verification & Management:

• Conduct daily verification of insurance eligibility for all new and existing clients using a variety of portals (PSS, Availity, County Care, Meridian, Aetna, VA/Optum, Humana, Molina). Capture and upload proof of eligibility (screenshots) to each client's document profile in Axis Care. Maintain and meticulously update the master Eligibility Spreadsheet with accurate client data, including insurance IDs, authorization dates, and status flags (Active, Inactive, Terminated, Dis enrolled).
  
  Execute changes in the tracking system when a client's insurance changes or they are disenrolled.

2. Authorization Management & Renewal:

• Proactively manage the entire authorization lifecycle to prevent service gaps.
• Run monthly expiration reports from Axis Care to identify authorizations expiring in the following month.
• Initiate renewal requests with payers one month in advance, with a goal of completing all requests for the upcoming month at least one week prior to the month beginning.
• Streamline the renewal process by consolidating requests:
  Compile all expiring authorizations for a single IDoA Care Coordination Unit (CCU) onto one master spreadsheet and submit via a single email. Apply a similar consolidated approach for MCOs with standard renewal cycles (e.g., Aetna's 3-month authorizations).
• Provide necessary client information and documentation with each request. Process and keep record of IDOA/IDHS fax requests, manage confirmation pages.
• Diligently track all renewal requests and conduct systematic follow-ups with payers until the renewed authorization is received.
• Proactively identify and manage the client disenrollment process from start to finish upon notification or as discovered through routine eligibility checks.
• Ensure all disenrollments and MCO roll-offs are processed in a timely fashion to prevent billing issues and service gaps.
• Verify the client's new insurance via the PSS portal and initiate the authorization request with the new provider.
• Notify the Billing department, relevant Branch Manager, and Quality Control of the insurance change to ensure billing and service continuity.
• Accurately update the Disenrollment and Eligibility spreadsheets to reflect the transition.
• Serve as the central communication hub for eligibility and authorization statuses between insurance providers, Case Managers, and internal teams.
• Provide direct support to the billing team, and branches by verifying insurance and assisting with authorization-related issues for referrals.
• Maintain impeccable and timely documentation in Client Notes, Axis Care, and all tracking spreadsheets (Eligibility, Authorization, Disenrollment) for every action and communication. Communicate proactively with branches, sending monthly reports on expiring VA authorizations.

5. Problem-Solving & Departmental Support:

• Investigate and resolve authorization issues, such as missing start dates or incorrect provider information, by contacting insurers directly.
• Assist Case Managers by contacting clients to encourage attendance at redetermination appointments.
• Process and verify service extension requests from branches in accordance with payer-specific guidelines (3 months for MCOs/DORS; 12 months for IDOA).
• Provide support to the Billing department to resolve eligibility-related billing denials.

Qualifications & Skills:

• High school diploma or equivalent required;
  Associate's or Bachelor's degree in related field preferred.
• Minimum of 3 years of experience in a healthcare administrative role, with a strong focus on insurance verification, authorization, and eligibility.
• Proven experience with insurance portals (e.g., PSS, Availity, MCO portals) and Electronic Health Record (EHR) systems;
  Axis Care experience is a significant plus.
• Exceptional attention to detail and accuracy in data entry and management.
• Strong organizational and time-management skills, with the ability to manage multiple tasks and deadlines proactively.
• Excellent verbal and written communication skills.
• Ability to work independently with minimal supervision and as…