Medicaid Eligibility/Authorization Coordinator Sunshine Homecare Services

Position Summary

At Sunshine Homecare Services, we believe access to quality care begins with compassion, accuracy, and advocacy. We are seeking a dedicated Medicaid Eligibility / Authorization Coordinator who is passionate about supporting patients and families by ensuring uninterrupted insurance coverage and timely authorizations. This role is vital to our mission, serving as a key liaison between patients, families, payers, and internal teams. The Coordinator ensures that eligibility, authorizations, and compliance requirements are met so our clients can receive care without delay across all Sunshine Homecare agencies.

Qualifications

• Bachelor's Degree with 35 years of experience in Medicaid eligibility and authorization management within a healthcare setting, including acquiring and maintaining authorizations for Medicaid and other insurance plans
• Knowledge of NHTD and TBI program requirements and regulations is a plus
• Experience working directly with patients, family members, service coordinators, Medicaid representatives, and insurance companies
• Ability to read, write, and comprehend instructions, short correspondence, and memos; ability to draft professional written communications
• Strong verbal communication skills, with the ability to effectively present information in one-on-one and small-group settings
• Proficiency in office equipment and computer applications, including Microsoft Word and Excel
• Strong organizational, interpersonal, and time-management skills
• Ability to apply common-sense reasoning to carry out instructions and resolve routine issues
• Ability to manage standardized processes with occasional variables in a fast-paced environment

Contacts

External Contacts: Patients and patient families, service coordinators, Medicaid representatives, insurance companies, outside billing vendors

Internal Contacts: Administrative staff, intake team, finance department

Equipment Used

Computer, telephone, copier, fax machine

Specific Duties & Responsibilities

• Confirm patient insurance coverage and eligibility for services prior to admission and before services are rendered
• Obtain initial and ongoing authorizations from Medicaid and insurance companies, ensuring all required documentation is submitted accurately and timely
• Serve as a liaison between patients, families, insurance representatives, service coordinators, and clinical staff to facilitate the authorization process and resolve issues
• Gather and submit all required documentation for patients enrolled in NHTD and TBI programs
• Track patient eligibility status and ensure continuous enrollment to prevent service interruptions
• Submit required documentation to Medicaid for fee-for-service patients, including pediatric cases
• Develop and maintain a tracking system for expiring authorizations, reviewing weekly to prevent lapses that may result in non-payment
• Follow up on outstanding authorization requests to ensure timely determinations and continuity of care
• Provide clear information and support to patients and families regarding insurance coverage and authorization processes, promoting a positive patient experience
• Maintain accurate and compliant records of all authorization requests, approvals, and denials in accordance with regulatory and internal policies
• Perform other duties as assigned by the Controller

Customer Service & Interpersonal Skills

• Assists team members as needed
• Demonstrates cooperation and professionalism with patients, families, supervisors, and colleagues
• Maintains a friendly, respectful, and professional work environment
• Accepts constructive feedback and adjusts performance accordingly
• Uses established communication channels effectively
• Respects individuals and seeks assistance appropriately when needed

Specialized Skills & Technical Competencies

• Proficiency in ePACES and electronic eligibility systems
• Experience with HHA Exchange preferred
• Strong telephone and customer service skills
• Word processing and spreadsheet management
• Accurate data entry skills

Benefits

• 401K Retirement Plan & Employer Matching
• Health Insurance (Medical, NY STD), Dental, Vision
• Employer Sponsored Flexible Spending Account (FSA)
• Generous Paid Time Off (PTO) Package
• 7 legal holidays

Physical Demands

The physical demands described below are representative of those required to perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

Sedentary Work: Exerting up to 10 pounds of force occasionally and/or negligible force frequently. This position involves prolonged periods of sitting and extended computer use.