Prior Authorization Coordinator

Position:         Prior Authorization Coordinator

Reports to:     Director of Nursing

Revised:         01/20/2025

Job Summary: The Home Care Scheduler supports the office manager and clinical manager in performing daily operational functions within Brockton Home Health Care office. Primary duties include scheduling (communicating shift assignments to caregivers and clients), and HR/payroll management. The ideal candidate has previous experience working in a customer service or administrative role, preferably in the health care or home health industry, and experience in caregiving.

About Brockton Home Health Care

Brockton Home Health Agency is a Medicaid and Medicare certified in Massachusetts and accredited by the Joint Commission - Accreditation of Healthcare Organizations (JCAHO). Our mission is to provide each client and family with a sense of comfort, knowing they are being cared for by professionals that are exceptional in their field and who are innately invested in the well-being of others

Highlights:

• Brockton Home Health Care offers a comprehensive benefits plan that includes the following:
• Paid time off,
• 401k, Roth IRA
• Direct deposit.
• Health Insurance
• Dental Insurance
• Vision Insurance
• Mileage reimbursement for all field travel.
• Great environment to work

Qualifications:

·        2 years of prior authorization/referral experience in a Home Health Care setting

·        Must have excellent written and verbal skills

·        Strong attention to detail, organizational skills and ability to meet deadlines and work efficiently

·        Must have the ability to multitask and adapt to working under pressure

·        Excellent phone etiquette

·        Excellent customer service skills

·        Must be able to problem solve and think outside the box

·        Must be able to work as a team player

·        Fast learner

·        Excellent computer skills

·        Preferred Associate degree

Responsibilities:

Request, track, and obtain prior authorizations from insurance carriers/third party authorization companies within a reasonable time frame.

 Contact insurance carriers to verify patient’s insurance benefits and requirements specific to the requested radiology procedures.

 Follow up with insurance provider’s authorization companies prior to services being performed to secure prior authorization.

 Work closely with referring Insurance providers, Physician office, Hospitals, Health centers and communities to obtain necessary data needed to submit for prior authorization.

 Maintains a level of productivity suitable for the department

Communicate any insurance changes or trends back to management and the scheduling team

Work closely with clinical team, schedulers and Referrals department

Ensure compliance with federal and state regulations regarding Home Health Care submissions and quality assurance standards.

Participate in care planning meetings to discuss resident needs and coordinate appropriate interventions.

Facilitate communication between departments to ensure continuity of care, particularly for patients transitioning from critical care or home care settings.

As an accredited, regulated, certified, and licensed home health care provider, Brockton Home Health Care complies with all state/local mandates.

Brockton Home Health Care, and its associated entities and joint venture partners, are Equal Opportunity Employers. All employment decisions are made on a non-discriminatory basis without regard to sex, race, color, age, disability, pregnancy or maternity, sexual orientation, gender identity, citizenship status, military status, or any other similarly protected status in accordance with federal, state and local laws. Hence, we strongly encourage applications from people with these identities or who are members of other marginalized communities.

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