Verification Coordinator

Pinnacle Career•Oldsmar, FL

About The Position

Are you looking to make a difference in patients’ lives with a company that values your expertise? Join us in our mission of delivering compassionate healthcare where it matters most – at home. Pinnacle Home Care, Florida’s largest independent Medicare-certified home health provider, has been delivering high-quality, patient-centered care for over two decades, and we’re looking for a Verification Coordinator to join our award-winning team.

Requirements

High school diploma or equivalent required.
Minimum 1 year of experience in healthcare, insurance authorization, or medical office coordination required.
Strong understanding of insurance benefits and authorization processes.
Excellent verbal and written communication skills.
Ability to multitask, prioritize, and manage high-volume workflows.
Detail-oriented with strong organizational and documentation skills.
Proficient in Microsoft Office Suite, EMR systems, and health plan portals.
Exceptional customer service and problem-solving skills.
Ability to work collaboratively across departments.

Nice To Haves

Experience working with managed care organizations (HMOs, PPOs, Medicare Advantage) strongly preferred.
Familiarity with WellSky EMR System and Home Health Care is desired.

Responsibilities

Review patient charts after eligibility is confirmed to determine payer type, co-pay, visit limitations, and authorization requirements.
Verify assigned PCPs for HMO payers to ensure the patient is established and that the PCP will provide authorization.
Submit initial authorization requests to health plans or PCP offices as required.
Track and follow up on all submitted authorizations until approval is received.
Maintain complete documentation of authorization status, communications, and outcomes in Enterprise Referral Manager (ERM).
Contact patients to review benefits, confirm need for service, collect co-pay, and address insurance questions or concerns.
Provide clear explanations of insurance coverage, financial responsibility, and next steps in the authorization and onboarding process.
Document all patient communications in ERM.
If a patient declines care, record the reason, notify the POD and Care Coordinator via email, and document an Activity Note.
Contact PCPs to confirm patient status, last visit, and willingness to sign orders.
Determine whether a follow-up visit is needed prior to authorization.
Verify if the patient is active with another home health agency and confirm any preferred agency designations.
Obtain the correct fax numbers for sending authorization requests.
Submit for authorization once all necessary information is verified.
Record all activities and communications in Enterprise Referral Manager.
Notify the Clinical Intake Team and related departments once authorizations are received.
Report barriers or delays in obtaining authorizations to the Verifications Team Lead for escalation and resolution.
Maintain compliance with all documentation standards and organizational policies.
Meet or exceed performance metrics, including turnaround times, follow-up intervals, documentation accuracy, and patient contact rates.
Participate in regular audits, quality reviews, and team meetings.
Maintain up-to-date knowledge of payer requirements, authorization procedures, and internal workflows.