Insurance Authorization Coordinator

Kaplan International; Pennsylvania; Hybrid; USD 25,000 - 30,000; Full time

Benefits offered by this job

Medical Benefits: Health, Vision, &amp

Retirement: 401K & Pension with 4%

Job summary

Kaplan International is hiring an Insurance Authorization Coordinator to verify benefits and obtain authorizations before care starts. The role collaborates with multiple departments via EMR (HomeCare Homebase) and requires timely funding source updates. Work hours are 40 per week, Mon–Fri 8:30 AM–5 PM ET, with every-other Saturday.

Remote nationwide, living in the Eastern Time Zone preferred. Benefits include health, vision, dental, a 401K with employer contributions, and PTO.

Qualifications

• Associate degree or equivalent preferred.
• Minimum 1 year of experience in insurance verification/authorization or medical billing.
• Proficiency in Microsoft Office Suite.
• Knowledge of Medicare/Medicaid and third-party insurance requirements.
• Familiarity with HomeCare Homebase preferred.
• Strong attention to detail and good communication.

Responsibilities

• Obtain benefit information from payer portals and coordinate with hospitals and physician offices.
• Validate patient data and document payor details in the EMR.
• Reduce write-offs by documenting deductibles, co-pays, co-insurance, and out-of-pocket maximums.
• Monitor authorization workflow: initial authorization, reauthorization, and updates.
• Communicate with insurance companies and notify staff of approvals/denials.
• Support scheduling with funding sources and assist billing with verifications.

Skills

Verbal communication

Written communication

Detail oriented

Teamwork

Critical thinking

Independent work

Education

Associate degree or equivalent

Tools

Microsoft Office Suite

HomeCare Homebase

Job description

Job Title

Insurance Authorization Coordinator

Location

Remote/Nationwide, USA

Employee Type

Employee

Working Hours Per Week

40

Job Description

Homecare Homebase Experience (HCHB) is strongly preferred. Hours: Monday - Friday 8:30AM - 5PM, (MUST LIVE IN EASTERN TIME ZONE TO BE CONSIDERED). MUST BE WILLING TO WORK EVERY OTHER SATURDAY.

Compensation: $18.00 - $22.00. The base compensation range for this role is fixed, with a maximum cap of $22.00. We want to be transparent about this as we continue discussions.

• Medical Benefits: Health, Vision, & Dental
• Retirement: 401K & Pension w/ 4% employer contribution
• PTO: 15 Days

SUMMARY

The Insurance Verification & Authorization Coordinator ensures that benefit information, authorization, and patient liability are obtained prior to clinical staff starting care for any service lines and branches. Work closely with other departments to ensure that correct funding source information is updated in a timely manner. Daily tasks will be driven by assigned workflow in the EMR (Homecare Homebase).

INSURANCE VERIFICATION & AUTHORIZATION COORDINATOR DUTIES AND RESPONSIBILITIES

• Obtain detailed and accurate benefit information using payer portals, phone, or fax for all insurance companies accepted by Home Health product lines
• Validate and document all payor information such as patient name, DOB, and policy number in the EMR
• Reduce write-offs by clearly documenting benefit information such as deductibles, co pays, co-insurance, and out-of-pocket maximums in the patients’ charts through coordination notes
• Continuously monitor task flow screen related to all insurance issues including but not limited to the following: verify Medicare eligibility, follow up to on-call completed insurance, complete insurance verification, review eligibility alerts, obtain initial authorization, re-verify insurance at recertification, and resumption of care
• Review of entitlement verification reports daily, researching any questionable answers
• Review problems related to all insurance changes daily
• Review of issues related to funding source updates daily
• Reverify current Medicaid patients to monitor HMO status monthly
• Reverify current patients’ insurances monthly to monitor for any payer changes or other agencies monthly
• Contact patients, hospitals, or physician offices for information or to clarify benefit
• Assist scheduling with funding source problems related to scheduling out visits to clinical staff
• Reduce write-offs by working with the clinical staff to ensure transfer of agency/provider of choice forms are received and sent to the other agency within the appropriate timeframes
• Obtain detailed and accurate authorization, prior authorization, and ongoing authorization as required by insurance companies accepted by the company via phone, fax, or payer portal
• Understand and maintain the authorization tab in HCHB
• Provide clinical information as requested by insurance companies
• Contact insurance companies as needed to review authorization submissions and requests for more clinical information and notify internal clinical staff of authorization approvals and denials
• Continuously monitor task flow screen related to all authorization issues including, but not limited to the following: determine if reauthorization needed for new orders, follow up on on-call completed authorizations, obtain initial authorization, obtain reauthorization, and update pending authorization with actual authorization information
• Assist scheduling with funding source problems related to scheduling out visits to clinical staff
• Assist billing department insurance verification discrepancies or authorization discrepancies which could hold up claim submission
• Establish a thorough knowledge of all payer portals
• Comply with the company’s Core Values and Core Competencies
• Perform other duties as assigned

INSURANCE VERIFICATION & AUTHORIZATION COORDINATOR

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Associate degree or combination of experience and business courses preferred
• Minimum of one (1) year of previous experience in insurance verification, authorization, or medical billing
• Proficiency in Microsoft Office Suite
• Knowledge of Medicare, Medicaid, and third-party insurance and authorization requirements
• Knowledge of insurance websites
• Knowledge of HomeCare Homebase preferred
• Conscientious, with attention to detail
• Demonstrated patience, flexibility, and cooperative attitude
• Ability to think critically and act independently when resolving benefit discrepancies
• Effective verbal and written communication skills with others both internally and externally
• Ability to work independently and within a multidisciplinary team
• Availability weekends, holidays, and after hours based on business needs

CERTIFICATES, LICENSES, REGISTRATIONS

Must have and maintain in good standing a professional license, certificate, or registration, as applicable.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing