Authorizations Coordinator - LVN

About HealthFlex: Looking to make a difference? Join a team founded by nurses, where empathy is our driving force. At our agency, we believe healing happens best in the comfort of home, allowing patients and their families to cherish their time together. As one of the nation's largest privately owned agencies, we're dedicated to serving communities across the San Francisco Bay Area, North Bay, Central Valley, and the Greater Sacramento Area. If you're passionate about making a meaningful impact, we'd love to have you on board.

Position Summary: The Authorization Coordinator plays a crucial role in supporting the seamless delivery of home health services. Responsibilities include obtaining and verifying insurance authorizations, ensuring compliance with regulatory guidelines, and coordinating with internal and external stakeholders to facilitate patient care. This role requires strong communication, organization, and problem-solving skills to maintain efficient authorization workflows.

Location: Fairfield or Sacramento Office

Schedule: 9am-5pm Monday - Friday

• Note, this is not a remote position

Compensation: $40-$42/hr; Is determined by the following factors; experience, knowledge, skills, location, as well as internal equity and alignment with market data.

Essential Duties and Responsibilities:

This section describes the essential functions of this role; however, this is not intended to be all-inclusive. Other duties may be assigned as necessary. Reasonable accommodations may be provided to enable individuals with disabilities to perform the essential functions of this job.

Primary Responsibilities:

• Obtain, track, and verify insurance authorizations for home health services, ensuring approvals align with patient care needs.
• Communicate with insurance providers, physicians, and clinical teams to secure necessary documentation and resolve authorization-related issues.
• Maintain accurate and up-to-date records of authorizations, denials, and appeals in the electronic medical records (EMR) system and associated logs.
• Monitor authorization expirations and proactively work with clinical teams to request extensions or renewals as needed.
• Assist in identifying trends related to authorization delays or denials and recommend process improvements.
• Ensure compliance with Medicare, Medicaid, and commercial insurance policies regarding authorization requirements.
• Collaborate with Intake, billing, and clinical teams to facilitate seamless patient care transitions.
• Provide timely updates to appropriate stakeholders regarding the status of insurance authorizations.
• Ensure timely and accurate submission of authorization requests
• Track and follow up on authorization requests to ensure timely receipt from insurance providers
• Maintain a systematic workflow to prevent the need for retro authorizations in the delivery of patient care
• Appropriately audit patient care records to define the clinical and skilled needs when completing authorization requests. If such a need is unclear, undefined, or obsolete, collaborate with clinical team members to verify and justify the skilled need
• Ensure that the justification for authorization is valid, complete, and accurate
• Collaborate in the education, onboarding, and training of new team members

Benefits:

• We offer a variety of health plans to meet your needs; including HSA and FSA options
• Health benefits are inclusive of dependent coverage, medical, dental and vision
• Generous PTO and Paid Holidays so you can enjoy a work/life balance
• Healthy 401K matching and participation begins after 90 days of employment
• Employee Assistance Program
• Rewards program where points are redeemed for gifts of choice
• Other perks such as Pet Insurance and discounts to a variety of services

Acknowledgements and Awards:

• 7 time winner of “Best & Brightest Places to Work”
• 6 time winner of “Inc 500 Fast Growing Companies”
• Winner of “Better Business Bureau Torch Award”
• 4.6 Star Glassdoor Rating
• 5 Star Medicare Quality Rating

• Current California Licensed Vocational Nurse (LVN)
• Experience in health insurance authorizations is required, preferably in the Home Health environment.
• Strong organizational skills, attention to detail, proficiency in EHR systems, and understanding of HIPAA regulations.
• Excellent written and verbal communication skills.
• Proficiency in Google Suite and other relevant software.