Eligibility & Authorization Coordinator

AgeRight Care Management; Milwaukie, Northern (OR, KY); Hybrid; USD 45,000 - 75,000; Full time

Job summary

AgeRight Care Management in Milwaukie, OR is seeking a Home Health Eligibility & Authorization Coordinator to verify insurance benefits, obtain prior authorizations, and ensure timely admission and continuation of home health services.

The role requires collaboration with referrals, clinicians, and payers, maintaining authorization logs, and ensuring compliance with CMS, Medicare, Medicaid, and commercial payers, while documenting accurately in EMR systems.

Qualifications

• High school diploma required; associate or bachelor degree preferred.
• Experience in home health intake, insurance verification, authorizations, or healthcare administration preferred.
• Knowledge of payer requirements and CMS/Medicare guidelines is important.

Responsibilities

• Verify insurance eligibility and benefits prior to admission.
• Obtain and track prior authorizations and recertifications.
• Review referrals for payer requirements and coverage criteria.
• Coordinate with referral sources, clinicians, and payers.
• Maintain authorization logs and expiration dates.
• Resolve authorization denials and request additional documentation.

Skills

Medicare knowledge

Medicaid knowledge

EMR systems

Payer regulations

Communication

Organization

Problem-solving

Education

High school diploma

Associate degree preferred

Bachelor's degree preferred

Job description

Overview

Home Health Eligibility & Authorization Coordinator

Milwaukie, OR

Position Summary

Coordinates insurance verification, payer eligibility review, prior authorizations, and documentation requirements to ensure timely admission and continuation of home health services.

Essential Duties and Responsibilities

Verify insurance eligibility and benefits prior to admission. Obtain and track prior authorizations and recertifications. Review referrals for payer requirements and coverage criteria. Coordinate with referral sources, clinicians, and payers. Maintain authorization logs and expiration dates. Resolve authorization denials and request additional documentation. Support timely intake processing and patient admission. Ensure compliance with CMS, Medicare, Medicaid, and commercial payer requirements. Maintain accurate records in EMR systems. Generate reports related to authorization status and payer trends.

Qualifications

High school diploma required; associate or bachelor degree preferred. Experience in home health intake, insurance verification, authorizations, or healthcare administration preferred.

Knowledge and Skills

Knowledge of Medicare, Medicaid, managed care, EMR systems, payer regulations, communication, organization, and problem-solving skills. Be open to cross-training on the other positions under the intake department.

May other tasks will be asked, added or removed from this job description based on the agency needs.

Performance Expectations

Timely authorization processing, accurate eligibility verification, reduced authorization denials, regulatory compliance, strong customer service, and effective communication.

AgeRight Care at Home provides individualized and comprehensive levels of in‑home assistance, with a goal to help keep patients where they want to be for as long as possible. AgeRight Care at Home is part of Marquis Companies and Consonus Healthcare. We are connected as a network of facilities that provide assisted living, long term care, post‑acute rehab, as well as rehab and pharmacy services to residents in Oregon, Nevada and California. These connections and resources provide employees of AgeRight the ability grow and pursue a career in healthcare.

EEO Statement

“Be here. Be you.”

For more than 30 years, AgeRight has been serving seniors and welcoming staff of all backgrounds, skills, and perspectives. The Marquis family of companies offer a rich heritage of embracing differences and honoring individuality. We’ve continued to grow in our appreciation of diversity in the workplace. We know it builds strength, drives innovation, and brings valuable new perspectives and energy.

We’re committed to making our workforce an even greater reflection of the people and communities we serve, and we are honored our employees have chosen to work at Marquis, Consonus and AgeRight. Everything we do as a company is driven by our mission to help those we serve, and each other, live the best rest of our lives.

That means you being you – without apology or compromise. We value your every uniqueness and continue to curate, nurture, and sustain an inclusive culture. It’s the foundation of who we are and the evolution of our collective future.