Central Auth Coord - HHH

About the role

We’re looking for a Central Authorization Coordinator who is passionate about making a difference in the lives of those who need healthcare or are embracing the next chapter of their lives. You’ll coordinate and process all new and extended cases within the Central Authorization Department, verifying insurances, setting up patient demographic and billing information, and submitting all insurance authorizations required by the payer—all with accuracy and deep knowledge of third-party payers, in line with company, federal, state, and local standards.

Responsibilities

• Authorization Verification and Management (60%)
  • Complete all workflow-assigned authorization tasks within primary workflow software in a timely and accurate manner for home health and hospice services.
  • Upload and index all relevant documentation to client attachments within primary workflow software, specifically regarding authorization approval and updates.
  • Submit all required authorizations using payer-based web portals or fax, as applicable.
  • Complete all necessary items to finalize pending authorizations; update primary workflow software with relevant changes to authorization status, frequency, and dates.
  • Respond to all email and phone requests from sites in a timely and professional manner.
  • Escalate all known issues of concern to the Division Manager of Accounts Receivable - HHH or Central Admissions Supervisor in a timely manner.
  • Complete all recertification on existing authorizations, as supported by continuation of services by physician orders.
  • Notify site personnel of any existing issues relating to the validity and/or finalization of authorization of services rendered.
  • Review authorization workflow for newly opened admission or recertification; verify patient homebound status when required. If patient is no longer homebound, determine if alternative insurance is available that doesn’t require homebound status.
  • Complete coordination notes of authorization activity to assure timely communication with locations and billing staff.
  • Maintain accurate insurance plan knowledge of all prior authorization requirements (e.g., ensuring alignment of patient orders, discipline visits, and authorization requests).
  • Track all appeals and appeal decisions to assure authorization requests are reconciled with visits; communicate appeal decisions with locations.
  • Update pending authorizations by checking status of authorizations awaiting determination, contacting payors, and verifying payor portals for results.
  • Re-verify patient eligibility and benefits monthly to assure patients’ insurance plans are still active.
  • Respond to additional documentation requests from insurance plans for information required to provide necessary authorizations.
  • Validate accuracy of central intake data input of patient demographic information and selection of primary payor based on coordination of benefits.
  • Work within electronic medical records software to process authorizations and denials appropriately; notify location after authorization adjustments have been completed.
• Appeal Tracking and Administration (20%)
  • Send medical record appeal packets sent by therapy vendors, Director of Nursing, Regional Directors of Clinical Operations (RDCO), and administrative staff.
  • Enter all tracking information and appeal updates on the Additional Development Request (ADR) log.
  • Systematically review Retrospective Post Payment Medical Record Reviews for takeback adjustments and clear entries over 90 days old that have not been adjusted or resubmitted by entering payment amount on ADR log.
  • Communicate with Third Party Accounts Receivable Coordinators and RDCOs on all appeal correspondences and updates.
• Data Entry (20%)
  • Create facesheets, as needed, and verify that all demographic and billing information is accurate and complete through validation of patient-supplied information from the referring facility.
  • Complete all authorization-related workflow tasks, as needed, for data integrity.
  • Ensure statement set-up is complete prior to month-end close.
  • Enter all authorization numbers for all services in billing systems in a timely and accurate manner.
  • Track all outpatient start and end of care episodes in the electronic medical records system.
  • May be responsible for therapy billing code entry.
• Perform all other duties as assigned.

Requirements

• High school diploma or equivalent required.
• Experience in insurance and billing required.
• Experience in long-term care, hospital, or other related healthcare accounting preferred.
• Experience with Medicare Advantage and Medicaid eligibility preferred.
• Proficiency with Windows, Microsoft Office (Word, Excel, PowerPoint), and the internet required.
• Must be able to read, write, speak, and understand the English language.

Working Conditions

• Sitting: Up to 8 hours/day
• Standing: Up to 2 hours/day
• Walking: Up to 2 hours/day
• Lifting, transferring, pushing, or pulling equipment/supplies: Up to 25 pounds
• Driving: Up to 6 hours/day
• Work weekends, evenings, and holidays: As needed for coverage
• Risk Category for Exposure to Bloodborne Diseases: III