Insurance & Authorization Coordinator

Graham Healthcare Group is seeking an Insurance Verification & Authorization Coordinator who will ensure 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 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 Insurance Verification & Authorization Coordinator requirements. - 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 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. NOTICE : Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana. By supplying your phone number, you agree to receive communication via phone or text. By submitting your application, you are confirming that you are legally authorized to work in the United States. JR# JR245249 Learn More