Insurance Authorization Coordinator

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🕒 Março 18

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Pennant

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2010

💰 $108.500.000 Post-IPO Equity - The Pennant Group em 2024-10

No Pennant, somos movidos por uma verdade simples: cuidados excepcionais começam com liderança excepcional. Entendemos que líderes locais são o coração dos cuidados locais, e capacitá-los é a chave para oferecer um Serviço que Transforma Vidas em cada comunidade que atendemos.

Descrição

• Oversee the timely and accurate submission and tracking of all initial insurance authorization requests for home health and hospice patients. • Work closely and effectively with the scheduling teams to coordinate start of care and ensure clinical services are only delivered after authorization is confirmed. • Direct the process for obtaining authorization following the 485 (Plan of Care) submission and managing all add-on insurance authorizations when required for changes in the patient's plan of care (e.g., increased visits, new services). • Establish and monitor the process for the team to re-verify eligibility on the 1st and 5th of each month for all active patients to proactively identify and resolve any changes in insurance status. • Serve as the escalation point for complex authorization denials or issues, communicating directly with various insurance carriers. • Ensure all authorization processes are compliant with payer contracts and regulatory standards. • Generate reports on authorization status, denial rates, and turnaround times.

🎯 Requisitos

• Minimum of 3 years of dedicated experience in insurance verification and authorization, specifically within Home Health or Hospice. • Expert knowledge of Medicare, Medicaid, and commercial insurance authorization processes and documentation requirements for episodic and per diem payments. • Proficiency in using electronic medical record (EMR) systems and authorization tracking software. • Associate's or Bachelor's degree in Business, Finance, Healthcare Administration, or a related field. • Experience with utilization review and appeals processes.

🏖️ Benefícios

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development Opportunities