Intake and Eligibility Coordinator

Socket.dev; Niles (IL); On-site; USD 42,000 - 65,000; Full time

Benefits offered by this job

401(k)

401(k) matching

Dental insurance

Health insurance

Paid time off

Vision insurance

Job summary

Socket.dev is seeking an Intake and Eligibility Coordinator in Niles, IL to oversee insurance eligibility verification, authorization management, and disenrollment processes. This role interfaces with Case Managers, Billing, and branches to ensure seamless client care and accurate billing.

Ideal candidates have 3+ years in healthcare administration focusing on insurance verification and authorization, with experience in AxisCare, PSS, Availity, and EHR systems.

Qualifications

• High school diploma or equivalent required; associate's or bachelor's degree preferred.
• Minimum of 3 years of experience in a healthcare administrative role focusing on insurance verification, authorization, and eligibility.
• Experience with insurance portals (PSS, Availity, MCO portals) and EHR systems; AxisCare experience is a significant plus.

Responsibilities

• Verify insurance eligibility for new and existing clients daily across multiple portals; update master eligibility spreadsheet.
• Manage and renew authorizations; run monthly reports; consolidate requests for CCU and MCOs; track renewals and follow up with payers.
• Identify and manage disenrollment processes; verify new insurance; notify Billing and management to ensure continuity.
• Serve as hub for eligibility and authorization statuses; assist Billing and branches with authorization issues; maintain detailed documentation.
• Support Billing by resolving eligibility-related denials; assist Case Managers with redetermination reminders and service extension requests.

Education

Associate's degree or Bachelor's degree (related field)

High school diploma or equivalent

Tools

AxisCare

PSS

Availity

MCO portals

EHR systems

Job description

Intake and Eligibility Coordinator

Job description:

This role is primarily responsible for the meticulous management and verification of client insurance eligibility and authorizations. By proactively monitoring, renewing, and tracking all insurance-related data, the Coordinator ensures seamless, uninterrupted client care and enables the agency to bill accurately for services rendered. This position requires a high level of detail orientation, proactive communication, and expert navigation of various insurance portals. Furthermore, this role provides essential support and serves as a key resource for many of the departments within Home Services.

Responsibilities:

1. Eligibility Verification & Management:

• Conduct daily verification of insurance eligibility for all new and existing clients using a variety of portals (PSS, Availity, CountyCare, Meridian, Aetna, VA/Optum, Humana, Molina). Capture and upload proof of eligibility (screenshots) to each client's document profile in AxisCare. Maintain and meticulously update the master Eligibility Spreadsheet with accurate client data, including insurance IDs, authorization dates, and status flags (Active, Inactive, Terminated, Disenrolled). Execute changes in the tracking system when a client's insurance changes or they are disenrolled.

2. Authorization Management & Renewal:

• Proactively manage the entire authorization lifecycle to prevent service gaps.
• Run monthly expiration reports from AxisCare to identify authorizations expiring in the following month.
• Initiate renewal requests with payers one month in advance, with a goal of completing all requests for the upcoming month at least one week prior to the month beginning.
• Streamline the renewal process by consolidating requests: Compile all expiring authorizations for a single IDoA Care Coordination Unit (CCU) onto one master spreadsheet and submit via a single email. Apply a similar consolidated approach for MCOs with standard renewal cycles (e.g., Aetna’s 3-month authorizations).
• Provide necessary client information and documentation with each request. Process and keep record of IDOA/IDHS fax requests, manage confirmation pages.
• Diligently track all renewal requests and conduct systematic follow-ups with payers until the renewed authorization is received.

3. Disenrollment Process Management:

• Proactively identify and manage the client disenrollment process from start to finish upon notification or as discovered through routine eligibility checks.
• Ensure all disenrollments and MCO roll-offs are processed in a timely fashion to prevent billing issues and service gaps.
• Verify the client's new insurance via the PSS portal and initiate the authorization request with the new provider.
• Notify the Billing department, relevant Branch Manager, and Quality Control of the insurance change to ensure billing and service continuity.
• Accurately update the Disenrollment and Eligibility spreadsheets to reflect the transition.

4. Communication, Collaboration & Documentation:

• Serve as the central communication hub for eligibility and authorization statuses between insurance providers, Case Managers, and internal teams.
• Provide direct support to the billing team, and branches by verifying insurance and assisting with authorization-related issues for referrals.
• Maintain impeccable and timely documentation in Client Notes, AxisCare, and all tracking spreadsheets (Eligibility, Authorization, Disenrollment) for every action and communication. Communicate proactively with branches, sending monthly reports on expiring VA authorizations.

5. Problem-Solving & Departmental Support:

• Investigate and resolve authorization issues, such as missing start dates or incorrect provider information, by contacting insurers directly.
• Assist Case Managers by contacting clients to encourage attendance at redetermination appointments.
• Process and verify service extension requests from branches in accordance with payer-specific guidelines (3 months for MCOs/DORS; 12 months for IDOA).
• Provide support to the Billing department to resolve eligibility-related billing denials.

Qualifications & Skills:

• High school diploma or equivalent required; Associate's or Bachelor's degree in related field preferred.
• Minimum of 3 years of experience in a healthcare administrative role, with a strong focus on insurance verification, authorization, and eligibility.
• Proven experience with insurance portals (e.g., PSS, Availity, MCO portals) and Electronic Health Record (EHR) systems; AxisCare experience is a significant plus.
• Exceptional attention to detail and accuracy in data entry and management.
• Strong organizational and time-management skills, with the ability to manage multiple tasks and deadlines proactively.
• Excellent verbal and written communication skills.
• Ability to work independently with minimal supervision and as part of a collaborative team.

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location:

• In-Person, Niles, IL

Monday - Friday 9AM to 5PM