Insurance Authorization Coordinator

Job Title

Insurance Authorization Coordinator

Remote/Nationwide, USA

Employee

40

Homecare Homebase Experience (HCHB) is strongly preferred.

Hours:

Monday - Friday 8:30AM - 5PM, (MUST LIVE IN EASTERN TIME ZONE TO BE CONSIDERED). MUST BE WILLING TO WORK EVERY OTHER SATURDAY.

Compensation: $18.00 - $22.00. The base compensation range for this role is fixed, with a maximum cap of $22.00. We want to be transparent about this as we continue discussions.

• Medical Benefits:
  Health, Vision, & Dental
• Retirement: 401K & Pension w/ 4% employer contribution
• PTO: 15 Days

The Insurance Verification & Authorization Coordinator ensures that benefit information, authorization, and patient liability are obtained prior to clinical staff starting care for any service lines and branches. Work closely with other departments to ensure that correct funding source information is updated in a timely manner. Daily tasks will be driven by assigned workflow in the EMR (Homecare Homebase).

• Obtain detailed and accurate benefit information using payer portals, phone, or fax for all insurance companies accepted by Home Health product lines
• Validate and document all payor information such as patient name, DOB, and policy number in the EMR
• Reduce write-offs by clearly documenting benefit information such as deductibles, co pays, co-insurance, and out-of-pocket maximums in the patients’ charts through coordination notes
• Continuously monitor task flow screen related to all insurance issues including but not limited to the following: verify Medicare eligibility, follow up to on-call completed insurance, complete insurance verification, review eligibility alerts, obtain initial authorization, re-verify insurance at recertification, and resumption of care
• Review of entitlement verification reports daily, researching any questionable answers
• Review problems related to all insurance changes daily
• Review of issues related to funding source updates daily
• Reverify current Medicaid patients to monitor HMO status monthly
• Reverify current patients’ insurances monthly to monitor for any payer changes or other agencies monthly
• Contact patients, hospitals, or physician offices for information or to clarify benefit
• Assist scheduling with funding source problems related to scheduling out visits to clinical staff
• Reduce write-offs by working with the clinical staff to ensure transfer of agency/provider of choice forms are received and sent to the other agency within the appropriate time frames
• Obtain detailed and accurate authorization, prior authorization, and ongoing authorization as required by insurance companies accepted by the company via phone, fax, or payer portal
• Understand and maintain the authorization tab in HCHB
• Provide clinical information as requested by insurance companies
• Contact insurance companies as needed to review authorization submissions and requests for more clinical information and notify internal clinical staff of authorization approvals and denials
• Continuously monitor task flow screen related to all authorization issues including, but not limited to the following: determine if reauthorization needed for new orders, follow up on on-call completed authorizations, obtain initial authorization, obtain reauthorization, and update pending authorization with actual authorization information
• Assist scheduling with funding source problems related to scheduling out visits to clinical staff
• Assist billing department insurance verification discrepancies or authorization discrepancies which could hold up claim submission
• Establish a thorough knowledge of all payer portals
• Comply with the company’s Core Values and Core Competencies
• Perform other duties as assigned

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Associate degree or combination of experience and business courses preferred
• Minimum of one (1) year of previous experience in insurance verification, authorization, or medical billing
• Proficiency in Microsoft Office Suite
• Knowledge of Medicare, Medicaid, and third-party insurance and authorization requirements
• Knowledge of insurance websites
• Knowledge of Home Care Homebase preferred
• Conscientious, with attention to detail
• Demonstrated patience, flexibility, and cooperative attitude
• Ability to think critically and act independently when resolving benefit discrepancies
• Effective verbal and written communication skills with others both internally and externally
• Ability to work independently and within a multidisciplinary team
• Availability weekends, holidays, and after hours based on business needs