Weekend Managed Care Coordinator

This is a fully remote position, open to applicants in Florida.

📋 Description

• Conduct daily verification of insurance eligibility and benefits for both new and existing patients.

• Evaluate patient insurance details and recognize payer requirements.

• Confirm coverage, benefits, restrictions, and authorization necessities.

• Track and reconcile changes in insurance coverage.

• Ensure accurate payer and patient data is maintained within the EMR system.

• Acquire initial authorizations for home health service provision.

• Keep track of authorization statuses and expiration timelines.

• Secure reauthorizations to facilitate ongoing patient care.

• Follow up with insurance providers and managed care organizations regarding pending authorizations.

• Accurately record authorization details within the EMR.

• Develop processes to avert authorization gaps.

• Navigate payer portals and electronic systems for authorizations.

• Submit necessary documentation to support authorization requests.

• Follow up on pending requests and address authorization-related challenges.

• Foster professional relationships with payer representatives.

• Maintain comprehensive records of eligibility, benefits, authorizations, and reauthorizations.

• Safeguard confidential patient and insurance data in compliance with HIPAA regulations.

• Adhere to company policies and established managed care procedures.

• Collaborate with the Intake team to ensure prompt referral processing.

• Work alongside Operations regarding authorization needs and patient status.

• Communicate with Sales and referral sources when payer information or authorization requirements impact patient acceptance.

• Appropriately escalate concerns regarding authorizations or potential coverage issues.

⛳️ Requirements

• Some college education.

• At least 2 years of recent experience in securing medical insurance authorizations.

• Proficiency in insurance eligibility and benefit verification.

• Experience interacting with insurance companies and managed care organizations.

• Familiarity with navigating insurance portals and authorization systems.

• Experience working with an EMR or electronic healthcare documentation system.

• Exceptional attention to detail and precision.

• Strong organizational skills and ability to follow through on tasks.

• Capability to handle multiple authorization requests and deadlines concurrently.

• Strong written and verbal communication abilities.

• Ability to collaborate effectively with various departments.

• Commitment to maintaining patient confidentiality and adhering to HIPAA standards.

• Preferred: experience in home health, hospice, healthcare, or another post-acute care setting.

• Preferred: understanding of home health insurance authorization and reauthorization protocols.

• Preferred: knowledge of medical terminology.

• Preferred: experience with various EMR platforms.

• Preferred: familiarity with Medicare Advantage, managed care, Medicaid, commercial insurance, or other healthcare payors.

• Preferred: experience in a high-volume Intake or Managed Care environment.

• Successful completion of an AHCA Level 2 background screening may be required.

🏝️ Benefits

• Comprehensive onboarding and training programs.

• Opportunities for professional advancement within Intake and Operations.

• Supportive leadership and a collaborative team atmosphere.

• Meaningful work assisting patients in accessing home health services.

• Exposure to diverse insurance plans and managed care processes.