Prior Authorization Coordinator - Home Health Care

Position:         Prior Authorization Coordinator

Reports to:     Clinical Manager

Revised:         05/21/2025

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

Job Summary: Brockton home Health Care is currently looking for a Prior Authorization Coordinator in home healthcare to ensure that services are authorized by insurance providers before being provided to patients. This role involves verifying insurance eligibility, confirming coverage, and managing the prior authorization process to prevent denials and billing issues. The Prior Authorization Coordinator will work with insurance providers, healthcare providers, and patients to ensure timely and accurate approvals.

Skills and Qualifications:

·        Strong communication skills: Excellent verbal and written communication skills for interacting with insurance companies, healthcare providers, and patients.

·        Attention to detail: Carefully reviewing insurance policies and authorization requests to ensure accuracy.

·        Organizational skills: Effectively managing multiple authorization requests and deadlines.

·        Customer service skills: Providing excellent service to patients and healthcare providers.

·        Computer proficiency: Ability to use computer systems and software to manage authorization requests and records.

·        Knowledge of insurance and medical terminology: Understanding of insurance policies, medical terminology, and billing practices.

Responsibilities:

·        Verifying insurance eligibility and benefits: This includes confirming that the patient is covered by the plan and that the services are eligible.

·        Confirming procedure coverage: Ensuring that the specific services or procedures planned for the patient are covered by the insurance plan.

·        Submitting and tracking prior authorization requests: This involves entering and tracking requests, coordinating phone calls, and ensuring timely follow-up with insurance providers.

·        Working with insurance companies: Communicating with insurance providers to obtain necessary information, resolve issues, and expedite approvals.

·        Managing authorization denials and appeals: Researching denial reasons, preparing appeals, and ensuring appropriate follow-up to resolve denials.

·        Maintaining accurate records: Keeping detailed records of authorization requests, approvals, and denials to ensure proper billing and compliance.

 Benefits:

• Flexibilities
• 401(k)
• Sick day
• Vacation
• Paid Holidays
• Health Insurance
• Dental
• Vision
• Great environment to work

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