Insurance Authorization Coordinator- Weekday Evening PRN

Deercreekseniorliving; Nashville (TN); On-site; USD 28,000 - 44,000; Full time

Job summary

The Pennant Group, Inc. is seeking an Insurance Authorization Coordinator for our Home Health and Hospice operations.

You will manage initial and ongoing payer authorizations, ensuring services are covered from admission through discharge, and you'll work closely with scheduling teams to coordinate start of care. Responsibilities include submitting initial requests, following 485 plan-of-care authorizations, monitoring eligibility on the 1st and 5th of each month, and communicating with carriers

Qualifications

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

Responsibilities

• Initial Authorization: submit and track all initial insurance authorization requests for home health and hospice.
• Collaboration and Communication: work with scheduling teams to coordinate start of care and ensure services occur after authorization.
• 485 and Add-On Authorization: manage authorizations after 485 plan of care submissions and add-ons when a plan changes.
• Ongoing Eligibility Management: re-verify eligibility on the 1st and 5th of each month for all active patients.
• Payer Relations: act as escalation point for denials or complex issues with insurance carriers.
• Compliance and Reporting: ensure processes comply with contracts and regulatory standards; generate denial and turnaround reports.

Skills

Analytical skills

Organizational skills

Regulatory compliance

Education

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

Tools

EMR systems

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.

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 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.

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 a 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.

If you are a results-oriented authorization expert

If you are a results-oriented authorization expert ready to lead a critical function that ensures our patients receive the care they need.

Employer and Culture

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.

Something that sets Synergy Shared Services apart from other companies is the quality of our most valuable resources – our people! We are dedicated to living out our culture as defined by our core values, “CAPLICO”: Customer Second Accountability Passion for Learning Love One Another Intelligent Risk Taking Celebrate Ownership By incorporating these principles at all levels of our organization, our employees feel valued and excited about their impact on our service centre team members and operational partners. Our culture fosters excellence both personally and professionally and promotes development that leads to continued success.

Equal Opportunity Employer

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.