Central Authorization Coordinator - Home Health & Hospice

Ohio Living•Lincoln, NE

About The Position

The Central Authorization Coordinator coordinates and processes new and extended cases in the Central Authorization Department workflow for home health and hospice services. The role verifies insurance, establishes patient demographic and billing information, and submits payer-required insurance authorizations accurately and in accordance with company standards and applicable federal, state, and local standards, guidelines, and regulations. The coordinator manages authorization workflows, documentation, recertifications, appeals, eligibility and benefit checks, payer follow-up, and communication with company locations and billing staff. The position also supports data integrity by validating patient information, maintaining authorization and appeal records, completing billing-system entries, and performing related duties as assigned.

Requirements

High school diploma or equivalent.
Experience in insurance and billing.
Proficiency with Windows, Microsoft Office (Word, Excel, and PowerPoint), and the internet.
Ability to read, write, speak, and understand English.

Nice To Haves

Experience in long-term care, hospital, or other related healthcare accounting.
Experience with Medicare Advantage and Medicaid eligibility.

Responsibilities

Complete assigned authorization workflow tasks for home health and hospice services accurately and on time.
Upload and index documentation related to authorization approvals and updates in the primary workflow software.
Submit required authorizations through payer web portals or by fax.
Complete outstanding requirements for pending authorizations and update authorization status, frequency, and dates in the workflow software.
Respond professionally and promptly to email and phone requests from sites.
Escalate issues of concern to the Division Manager of Accounts Receivable - HHH or Central Admissions Supervisor.
Complete recertifications for existing authorizations when continued services are supported by physician orders.
Notify site personnel of issues affecting the validity or finalization of service authorizations.
Review authorization workflows for new admissions and recertifications, verify homebound status when required, and identify alternative insurance options when a patient is no longer homebound.
Document authorization activity in coordination notes to support timely communication with locations and billing staff.
Maintain knowledge of insurance plan prior authorization requirements and ensure patient orders, discipline visits, and authorization requests align.
Track appeals and appeal decisions, reconcile authorization requests with visits, and communicate decisions to locations.
Check the status of pending authorizations, contact payors, and review payer portals for determinations.
Re-verify patient eligibility and benefits monthly to confirm insurance plans remain active.
Respond to insurance plans' requests for additional documentation needed to authorize services.
Validate central intake patient demographic data and primary payor selection based on coordination of benefits.
Use electronic medical records software to process authorizations and denials, and notify locations after authorization adjustments are completed.
Send medical record appeal packets provided by therapy vendors, the Director of Nursing, Regional Directors of Clinical Operations, and administrative staff.
Enter appeal tracking information and updates in the Additional Development Request (ADR) log.
Review retrospective post-payment medical record reviews for takeback adjustments and clear entries over 90 days old that have not been adjusted or resubmitted by recording the payment amount in the ADR log.
Communicate appeal correspondence and updates with Third Party Accounts Receivable Coordinators and Regional Directors of Clinical Operations.
Create patient facesheets as needed and verify demographic and billing information using information supplied by the patient or referring facility.
Complete authorization-related workflow tasks as needed to maintain data integrity.
Ensure statement setup is complete before month-end close.
Enter authorization numbers for all services into billing systems accurately and on time.
Track outpatient start-of-care and end-of-care episodes in the electronic medical records system.
Enter therapy billing codes when assigned.
Perform other duties as assigned.