Insurance and Authorization Coordinator

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🕒 May 20

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Graham Healthcare Group

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2003

⚕️ Healthcare Insurance

🏢 Enterprise

Healthcare Insurance • Enterprise

Graham Healthcare Group is a company focused on delivering high-quality post-acute care services by partnering with health systems to provide care in patient homes and communities. They address the fiscal challenges faced by healthcare providers through innovative home-based care models and collaborative partnerships. With a commitment to improving population health, clinical performance, and patient experiences, Graham Healthcare Group uses a buy-and-hold strategy with permanent capital to ensure long-term partnerships. They serve over 80,000 patients annually, working closely with hospitals, health systems, and physician groups to enhance post-acute service lines and drive efficiency. Their main goal is to offer integrated care solutions that improve operational, financial, and clinical outcomes while reducing healthcare costs.

📋 Description

• 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 • 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

🎯 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

🏖️ Benefits

• Health, Vision, & Dental • 401K & Pension w/ 4% employer contribution • PTO: 15 Days