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The Authorization Coordinator is essential in overseeing the entire prior authorization process. This role involves gathering crucial documentation, contacting Primary Care Providers (PCPs) and patients for additional information, and ensuring that all required prior authorizations are completed to facilitate billing. The Authorizations Coordinator is responsible for the accurate and timely identification and submission of both prior and retro authorization requests to payors. In addition to these responsibilities, the Authorization Coordinator interacts with insurance companies, patients, and home health agencies as necessary to secure prior authorizations. This position also requires meticulous documentation of account activities and the updating of patient and claim information to maintain accuracy and compliance with regulatory standards.

Essential Functions:

• Document eligibility, benefit, and authorization information in strict adherence to established guidelines to ensure accuracy and compliance.
• Conduct thorough research on patient accounts with invalid or missing authorization information. Engage in correspondence with insurance companies, patients, and Primary Care Providers (PCPs) to gather the necessary details. This process is crucial to ensure accurate, timely, and complete submission of claims.
• Verify that all prior authorizations and pre-service requirements are fulfilled in accordance with established protocols to ensure compliance and facilitate the timely processing of claims.
• Proactively manages and maintains all outstanding authorizations to enhance the billing process of clean claims, ensuring timely resolution and minimizing delays in reimbursement.
• Proactively engages with insurance companies to confirm that all patients have the necessary authorizations for the services provided, ensuring compliance and facilitating uninterrupted care. This includes regular follow-ups and updates to address any authorization issues promptly.
• Deliver exceptional customer service to patients while fostering and nurturing positive working relationships with both internal and external colleagues.
• Analyze and report on trends and issues related to prior authorizations that affect billing and reimbursement processes.
• Maintain comprehensive documentation of all account activities and respond to inquiries promptly to ensure effective communication and transparency.
• Conduct daily reviews of accounts to ensure compliance and accuracy while consistently meeting or exceeding all established production goals on a daily, weekly, and monthly basis. This proactive approach contributes to overall efficiency and effectiveness in account management.
• Collaborates and communicates effectively with colleagues across various departments to foster a cohesive working environment.
• Adheres to both written and verbal communication protocols to ensure clarity and consistency in information sharing.
• Review medical documentation thoroughly to verify that it adequately supports the necessity of the requested services.
• Undertakes additional related responsibilities as required or assigned, demonstrating flexibility and a commitment to supporting team objectives and organizational goals. This may include tasks that contribute to the overall efficiency and effectiveness of the department.

Use your skills to make an impact

Skill/Experience:

• Proven experience in the healthcare industry, demonstrating a comprehensive understanding of its operations and best practices.
• 1 to 3 years of experience in medical insurance verification or authorization, preferably within a Durable Medical Equipment (DME) or healthcare environment
• Proficient in Microsoft Office and Windows products
• Familiarity with medical terminology and its applications in the healthcare field.
• Comprehensive knowledge of healthcare insurance and authorization requirements across major payers, including Medicare, Medicaid, and commercial insurance plans.
• Excellent communication and organizational skills, enabling effective collaboration and efficient management of tasks and priorities.
• Highly detail-oriented with a proven ability to manage multiple tasks simultaneously, ensuring accuracy and efficiency in a fast-paced environment.
• Proficient in interpreting medical documentation and terminology, ensuring accurate understanding and application in relevant processes

Additional Information

• Hours of Operation: M-F / 8a-5p (ET)
• Schedule: Hybrid
• On-Call Expectation: As needed
• Location: 3325 Executive Way Miramar, FL 33025

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$40,000 - $52,300 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients’ homes. OneHome’s patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.

About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.