Weekend Managed Care Coordinator
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Job Description
Weekend Managed Care Coordinator securing insurance authorizations for Concierge Home Care’s home health patients. Verifying benefits, managing payer portals, and preventing authorization gaps.
Responsibilities:
- Complete daily insurance eligibility and benefit verification for new and existing patients
- Review patient insurance information and identify payer requirements
- Verify coverage, benefits, limitations, and authorization requirements
- Monitor and reconcile insurance changes
- Maintain accurate payer and patient information within the EMR
- Obtain initial authorizations for home health services
- Monitor authorization status and expiration dates
- Obtain reauthorizations to support continued patient care
- Follow up with insurance companies and managed care organizations regarding pending authorizations
- Document authorization information accurately within the EMR
- Maintain processes to prevent authorization gaps
- Navigate payer portals and electronic authorization systems
- Submit required documentation supporting authorization requests
- Follow up on outstanding requests and resolve authorization-related issues
- Maintain professional relationships with payer representatives
- Maintain complete records of eligibility, benefits, authorizations, and reauthorizations
- Protect confidential patient and insurance information in accordance with HIPAA regulations
- Follow company policies and established managed care processes
- Collaborate with Intake to support timely referral processing
- Partner with Operations regarding authorization requirements and patient status
- Communicate with Sales and referral sources when payer information or authorization requirements affect patient acceptance
- Escalate authorization concerns or potential coverage issues appropriately
Requirements:
- Some college
- Minimum 2 years of recent experience obtaining medical insurance authorizations
- Experience with insurance eligibility and benefit verification
- Experience communicating with insurance companies and managed care organizations
- Experience navigating insurance portals and authorization systems
- Experience working with an EMR or electronic healthcare documentation system
- Strong attention to detail and accuracy
- Excellent organizational and follow-through skills
- Ability to manage multiple authorization requests and deadlines simultaneously
- Strong written and verbal communication skills
- Ability to work collaboratively with multiple departments
- Ability to maintain patient confidentiality and follow HIPAA requirements
- Preferred: experience in home health, hospice, healthcare, or another post-acute setting
- Preferred: knowledge of home health insurance authorization and reauthorization processes
- Preferred: familiarity with medical terminology
- Preferred: experience working with multiple EMR platforms
- Preferred: experience with Medicare Advantage, managed care, Medicaid, commercial insurance, or other healthcare payors
- Preferred: experience working in a high-volume Intake or Managed Care environment
- Successful completion of an AHCA Level 2 background screening may be required
Benefits:
- Structured onboarding and training
- Opportunities for professional growth within Intake and Operations
- Supportive leadership and collaborative team environment
- Meaningful work helping patients access home health services
- Exposure to multiple insurance plans and managed care processes
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