Insurance Authorization Coordinator

Pennant Group; Nashville (TN); On-site; USD 40,000 - 60,000; Full time

Job summary

Pennant Group is seeking an Insurance Authorization Coordinator for our Home Health and Hospice services. You will ensure timely and accurate insurance authorizations from admission to discharge, collaborating with scheduling and clinical teams to validate coverage and pathways for care.

The role demands strong knowledge of payer requirements, meticulous attention to detail, and the ability to manage high-volume authorizations while maintaining regulatory compliance.

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 EMR systems and authorization tracking software.

Responsibilities

• Oversee timely and accurate submission and tracking of all initial insurance authorization requests for home health and hospice patients.
• Work closely with scheduling teams to coordinate start of care and ensure services are only delivered after authorization is confirmed.
• Direct the process for obtaining authorization following the 485 (Plan of Care) submission and managing add-on authorizations when required.
• Establish and monitor the process to re-verify eligibility on the 1st and 5th of each month for all active patients.
• Serve as the escalation point for complex authorization denials or issues, communicating with insurance carriers.
• Generate reports on authorization status, denial rates, and turnaround times.

Skills

Insurance verification

Authorization management

EMR software

Education

Associate’s or Bachelor’s degree in Business, Finance, Healthcare Administration, or related field

Job description

Insurance Authorization Coordinator-Home Health and Hospice

Join Pennant's dynamicinsurance authorizationteam asthe Insurance 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 all initialinsurance authorization requests for home health andhospicepatients.
• Collaboration and Communication: Work closely and effectivelywith 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 the485 (Plan of Care)submission and managing all add-on insurance authorizations whenrequiredfor changes in the patient’s plan of care (e.g., increased visits, new services).
• Ongoing Eligibility Management: Establishand monitor the process for the team to re-verify eligibility on the 1st and 5th of each month for 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 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.
• 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 skills withan 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.

The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at http://www.pennantgroup.com.