Insurance & Authorization Coordinator

SUMMARY

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).

INSURANCE VERIFICATION & AUTHORIZATION COORDINATOR DUTIES AND 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

INSURANCE VERIFICATION & AUTHORIZATION COORDINATOR:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Associate degree or combination of experience and business courses preferred
• 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
• Knowledge of HomeCare Homebase preferred
• 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

CERTIFICATES, LICENSES, REGISTRATIONS

Must have and maintain in good standing a professional license, certificate, or registration, as applicable.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee frequently lifts and/or moves up to 20 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions.

COMMENTS

This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

About Graham Healthcare Group:

As an innovator in an evolving healthcare world, Graham Healthcare Group has been designing business and technology solutions to drive better care, outcomes, and productivity within its own home health and hospice companies for over 20 years. In the last several years, our solutions have been successfully integrated across the healthcare continuum.

Join the Graham Healthcare Group and enjoy the following benefits:

• Competitive Pay: With opportunity for advancement

• Health and Welfare Benefits: Various medical, dental, and vision insurance options for you and your family to choose from.

• Supplemental Benefits: Company paid life insurance and disability benefits. Also, pre-tax FSA and HSA plans are offered.

• Generous PTO Packages.

• Retirement: Save for your future with our company offered 401k plan and pension.

• Company-Paid Education Programs: Grow your career by taking advantage of 50% discounts on tuition for selected courses offered by Purdue and Kaplan.

Benefits may vary based on your employment status.