Authorizations Coordinator

A.      Oversees the initiation of services for all new All American Home Care consumers by interfacing with the appropriate Managed Care Organizations.

B.      Works in conjunction with other All American Home Care departments to coordinate consumer and caregiver record accuracy in order to initiate or terminate consumer services.

C.      Maintains systems including but not limited to HHA Exchange for all new, terminating and ongoing consumers including eligibility and authorization checks.

D.      Responsible for documenting and communicating with all parties involved notices of eligibility issues included but not limited to consumers, care managers and MCOs.

E.       Assist in billing for all consumers that are under the DPW/Promise system.

F.       Obtaining and following up on authorizations.

G.      Working with the care managers to provide the documentation requested for continued authorization.

H.      Ensures that there is an authorization in place at all times for consumers under managed care plan.

I.         Obtain authorizations and monitor those authorizations for changes or exhaustion of benefits.

J.        Running authorization and eligibility reports.

K.       Verifies member eligibility and benefits.

L.       Distributes correspondence and other information to the appropriate parties or departments.

M.    Maintains appropriate logs, records, and reports of all authorizations submitted.

N.      Complete eligibility checks on the 1st and 16th of every month.

O.      Cross-train colleagues, as needed.

P.       Resolve simple to moderately complex issues, corrects errors and refers complex issues to supervisor.

Q.     Follows up on all claims requiring prior authorization.

R.      Assists Billing Department with resolving unbilled claims.

S.       Adjudicates and resolution of claim rejections as needed.

T.       Other responsibilities as assigned.

Qualifications 

·         Minimum of Associates Degree required, Bachelor’s Degree preferred or combination of experience.

·         2+ years experience in a Case Management or Billing support role to leadership staff.

·         Demonstrated capability maintaining strict confidentiality with employee information.

·         Knowledge of principles and practices of basic office management and organization.

·         Strong typing and computer application skills.

·         Computer proficiency and working knowledge of Microsoft programs required.

·         Strong interpersonal and business partnering skills.

·         Good judgement and decision-making skills.

·         Must be well organized, accurate and attentive to detail.

·         Excellent communication, public relations and follow up skills.

·         Must be able to work independently and have strong written and verbal communication skills.

·         Belief in the Home Care concept. 

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