Remote Insurance Authorization Specialist

Graham Healthcare Group; Northern (KY); Hybrid; USD 25,000 - 30,000; Full time

Benefits offered by this job

Health, Vision, & Dental insurance

401K & Pension with 4% employer match

PTO 15 days

Job summary

Graham Healthcare Group is seeking an Insurance Authorization Coordinator to verify benefits and obtain authorizations prior to providing home health services. This remote, nationwide role requires experience with insurance verification, authorization workflows, and Medicare/Medicaid knowledge.

The candidate must work 40 hours/week, Monday–Friday with alternating Saturdays and be in the Eastern Time Zone. Benefits include Health, Vision, Dental, 401K, PTO, and pension.

Qualifications

• Associate degree or combination of experience and business courses preferred.
• Minimum of one year experience in insurance verification, authorization, or medical billing.
• Proficiency in Microsoft Office Suite
• Knowledge of Medicare, Medicaid, and third‑party insurance requirements
• Knowledge of HomeCare Homebase preferred
• Strong attention to detail and communication skills.

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 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 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: 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

Skills

Attention to detail

Communication skills

Organizational skills

Independent work

Team collaboration

Education

Associate degree

Tools

MS Office Suite

HomeCare Homebase

Payer portals

Job description

Graham Healthcare Group is seeking an Insurance Authorization Coordinator to verify benefits and obtain authorizations prior to providing home health services. This remote, nationwide role requires experience with insurance verification, authorization workflows, and Medicare/Medicaid knowledge.

The candidate must work 40 hours/week, Monday–Friday with alternating Saturdays and be in the Eastern Time Zone. Benefits include Health, Vision, Dental, 401K, PTO, and pension.