Insurance & Authorization Coordinator

Graham Healthcare Group•Virtual PA, PA

4d•$18 - $22•Remote

About The Position

The Insurance Verification & Authorization Coordinator ensures that benefit information, authorization, and patient liability are obtained prior to clinical staff starting care for any service lines and branches. Work closely with other departments to ensure that correct funding source information is updated in a timely manner. Daily tasks will be driven by assigned workflow in the EMR (Homecare Homebase).

Requirements

Minimum of one (1) year of previous experience in insurance verification, authorization, or medical billing
Proficiency in Microsoft Office Suite
Knowledge of Medicare, Medicaid, and third-party insurance and authorization requirements
Knowledge of insurance websites
Conscientious, with attention to detail
Demonstrated patience, flexibility, and cooperative attitude
Ability to think critically and act independently when resolving benefit discrepancies
Effective verbal and written communication skills with others both internally and externally
Ability to work independently and within a multidisciplinary team
Availability weekends, holidays, and after hours based on business needs
Must live in Eastern Time Zone
Must be willing to work every other Saturday

Nice To Haves

Homecare Homebase (HCHB) experience is strongly preferred
Associate degree or combination of experience and business courses preferred
Knowledge of HomeCare Homebase preferred

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 but not limited to the following: verify 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 of 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 the following: 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