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Insurance Authorization Coordinator
2 months ago
ABOUT THE ROLE:
This position is essential in supporting our mission at Trilogy Health Services. The Insurance Authorization Coordinator will play a pivotal role in managing prior authorizations, recertifications, and insurance verifications for prospective admissions and therapy services.
Reporting to the Director of Payer Relations and Authorization Services, this role involves ensuring that residents have seamless access to necessary services by effectively gathering and processing information for verification and authorization from various insurance providers.
We offer competitive compensation, comprehensive health and dental benefits after the initial month, student loan repayment assistance, a robust 401(k) plan, and more. At Trilogy Health Services, we are dedicated to being the premier healthcare provider in the Midwest.
KEY RESPONSIBILITIES:
1. Execute tasks in centralized eligibility, prior authorization intake, or recertification as directed by the Payer Services Team Lead or Director.
2. Educate campus teams on authorization, recertification, and benefit eligibility processes.
3. Collaborate with the Business Office Manager and revenue cycle team to investigate denial issues related to eligibility or authorization.
4. Identify and address opportunities for improvement within the authorization and eligibility processes.
5. Validate and confirm patients' active insurance benefits, demographics, prior authorization needs, network status, and financial details to ensure reimbursement for services and minimize collection challenges.
6. Conduct online verifications and communicate with Insurance Carriers and Plan Administrators to confirm patients' benefits for both primary and secondary coverage.
7. Complete the Preadmission Financial Verification promptly before patient admission.
8. Assess whether override requirements are necessary based on established company thresholds and specific campus contracts.
9. Support campus teams by clarifying residents' benefits and requirements.
10. Verify and comprehend various insurance benefits for Skilled Nursing and Outpatient Therapy services.
11. Identify patient financial responsibilities.
12. Document accurate data related to eligibility, benefits, and precertification in the appropriate database fields post-admission or service delivery.
13. Maintain a comprehensive understanding of major insurance plans and their verification requirements.
14. Ensure that billing information and authorization requirements are effectively communicated to the campus teams to facilitate accurate claims processing.
15. Educate the clinical team on insurance requirements and limitations to ensure proper reimbursement and billing practices.
16. Negotiate Single Case Agreements with managed care and other insurance entities for reimbursement purposes.
17. Address escalated issues from payers, case managers, or campuses promptly and provide process audits to identify areas for improvement.
QUALIFICATIONS:
High School diploma or equivalent is required; a Bachelor's degree in accounting, business, or a related field is preferred.
A minimum of five years of experience in healthcare insurance within a healthcare, senior living, or long-term care environment is preferred.
OUR CULTURE:
At Trilogy, we are committed to creating a workplace that values diversity and inclusion. We are proud to be recognized as one of the Best Places to Work in Aging Services and are dedicated to fostering an environment where every team member can thrive.
