Insurance Authorization Coordinator- Weekend PRN

Pennant Group; Nashville (TN); Presencial; USD 52.000 - 72.000; Jornada completa

Descripción de la vacante

Pennant Group is seeking an Insurance Authorization Coordinator to join our Home Health and Hospice authorization team in Nashville. You will oversee initial authorizations, eligibility checks, and add-ons to ensure timely services and accurate billing.

You will collaborate with scheduling and clinical teams, navigate payer portals, and maintain compliance with Medicare, Medicaid, and commercial payers. This role requires meticulous attention to detail and strong problem-solving under

Formación

• 3+ years in insurance verification and authorization within Home Health or Hospice.
• Knowledge of Medicare, Medicaid, and commercial authorization processes.
• Proficiency with EMR and authorization tracking software.

Responsabilidades

• Oversee timely submission and tracking of initial insurance authorizations for home health and hospice patients.
• Collaborate with scheduling teams to coordinate start of care after authorization.
• Direct 485 submission and add-on authorization processes when required.
• Establish and monitor monthly eligibility re-verification for all active patients.
• Serve as escalation point for complex denials and payer issues.
• Ensure compliance and generate reports on status, denials, and turnaround times.

Conocimientos

Analytical skills

Organizational skills

Payer portal navigation

Interpersonal skills

Team leadership

Regulatory compliance

Educación

Healthcare/Business degree

Herramientas

EMR systems

Authorization software

Descripción del empleo

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.

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

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.