Insurance Authorization Coordinator

Hospice in the Pines; Nashville (TN); On-site; USD 52,000 - 76,000; Full time

Job summary

The Pennant Group, Inc. is seeking an Insurance Authorization Coordinator for Home Health and Hospice to ensure timely authorizations from admission through discharge. You will collaborate with scheduling teams and manage add-on and 485 authorizations, while maintaining compliance and accuracy.

The role requires deep knowledge of Medicare/Medicaid and commercial payer rules, plus proficiency with EMR and authorization tracking software, in a high-volume environment.

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.

Responsibilities

• Oversee timely submission and tracking of initial insurance authorizations for home health and hospice.
• Collaborate with scheduling teams to coordinate start of care after authorization.
• Direct the process for obtaining 485 (Plan of Care) and add‑on authorizations when required.
• Establish and monitor re-verification of eligibility on the 1st and 5th of each month.
• Serve as escalation point for complex denial issues with insurance carriers.
• Generate reports on authorization status, denial rates, and turnaround times.

Skills

Insurance verification

Authorization processes

Payer portals

Team collaboration

Education

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

Tools

EMR systems

Authorization tracking software

Job description

Insurance Authorization Coordinator-Home Health and Hospice

Join Pennant's dynamicinsurance authorizationteam 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.

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 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 the485 (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.

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

Preferred:

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

Skills and Competencies

• 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.

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.