Insurance Authorization Coordinator

Deercreekseniorliving; Nashville (TN); On-site; USD 50,000 - 70,000; Full time

Job summary

Deercreekseniorliving is searching for an Insurance Authorization Coordinator in Nashville, TN. The role requires overseeing insurance authorizations for home health and hospice patients, ensuring timely approvals to facilitate uninterrupted patient care.

Candidates should have a minimum of 3 years' experience in insurance verification, familiarity with Medicare and Medicaid processes, and proficiency in electronic medical records. Preferred qualifications include a degree in a relevant field and strong organizational skills.

Qualifications

• Minimum of 3 years of experience in insurance verification and authorization.
• Expert knowledge of authorization processes for episodic and per diem payments.
• Proficiency in using electronic medical record systems.

Responsibilities

• Oversee submission and tracking of insurance authorization requests.
• Collaborate with scheduling teams to coordinate delivery of clinical services.
• Manage ongoing eligibility re-verification for active patients.
• Serve as escalation point for complex authorization issues.
• Ensure compliance with payer contracts and regulatory standards.

Skills

Insurance verification and authorization

Knowledge of Medicare and Medicaid processes

Proficiency in EMR systems

Analytical skills

Education

Associate's or Bachelor's degree in Business or Healthcare Administration

Tools

Authorization tracking software

Job description

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.

Key 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.

Required Qualifications

• 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.

Preferred Qualifications

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

We are an equal opportunity employer committed to ensuring that all conditions and privileges of employment, including recruitment, hiring, evaluation, transfer, promotion, discipline, determination of compensation and/or benefits, and termination of employment, for all job classifications, are based on qualifications and work record. No employment decision is made, nor do we discriminate, on the basis of race, color, religion, creed, sex/pregnancy, sexual orientation, gender identity, gender expression, age, national origin, ancestry, citizenship, veteran status, or disability.