Insurance Authorization Coordinator

Insurance Authorization Coordinator-Home Health and Hospice 

JoinPennant’sdynamicinsurance authorizationteam astheInsurance Authorization Coordinator! We are looking for an exceptional team player toorchestratethe crucial function of securingtimelyandaccurateinsurance authorizations for our patients. Yourexpertisewill be key to ensuring uninterrupted care andoptimizingour 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.

Key Responsibilities

• Initial Authorization:Oversee thetimelyandaccuratesubmission and tracking of allinitialinsurance authorizationrequests for home health andhospicepatients.

• Collaboration and Communication:Work closely and effectivelywith thescheduling teamsto 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 the485 (Plan of Care)submission and managing alladd-on insuranceauthorizations whenfor changes in the patient's plan of care (e.g., increased visits, new services).

• Ongoing Eligibility Management:Establishand monitor the process for the team tore-verify eligibility on the 1st and 5th of each monthfor all active patients to proactivelyidentifyand resolve any changes in insurance status.

• Payer Relations:Serve as the escalation point for complexauthorizationdenials 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.

Qualifications

Required:

• Minimum of 3 years of dedicated experience ininsurance verification and authorization, specifically withinHome Health or Hospice.

• Expert knowledge ofMedicare, Medicaid, and commercial insurance authorization processesand documentation requirements for episodic and per diem payments.

• Proficiencyin using electronic medical record (EMR) systems and authorization tracking software.

Preferred:

• Associate'sorBachelor's degree in Business, Finance, Healthcare Administration, ora relatedfield.

• Experience withutilizationreview andappealsprocesses.

Skills and Competencies

• Superior analytical and organizational skillswithan unwaveringattention 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.

If you are a results-oriented authorization expert ready to lead a critical function that ensures our patients receive the care they need, apply today!