PHC Authorizations Coordinator

Job Description

Job DescriptionSalary:
About Us:At American Medical Home Health, we are dedicated to providing exceptional care and services to our patients and their families. We specialize in home health care & provider services and are committed to ensuring every patient receives the care they need through timely and accurate authorizations. We are currently seeking a detail-oriented and organized PHC Authorizations Coordinator to join our team.Position Summary:
The PHC Authorizations Coordinator plays a vital role in the coordination and processing of prior authorizations for patient care services. This individual will work closely with office staff, and payers to ensure timely submission and follow-up of all required documentation to secure authorizations necessary for patient care.Key Responsibilities:

• Manage and process all prior authorization requests for PHC (Personal Healthcare Services), ensuring timely submission to insurance providers and payers.
• Review patient referrals and clinical documentation to confirm completeness prior to authorization submission.
• Communicate with physicians, nurses, referral sources, and insurance companies to obtain any missing or additional documentation.
• Monitor and track authorization status, ensuring follow-up on pending requests to avoid service delays.
• Maintain accurate and up-to-date records in the EMR and authorization tracking systems.
• Collaborate with the billing department to ensure authorizations align with payer requirements and avoid claim denials.
• Stay current with payer guidelines, authorization requirements, and regulatory changes.
• Assist with audits and compliance reviews as necessary.

Qualifications:

• High School Diploma or equivalent required; associate or bachelors degree preferred.
• Minimum 1-2 years of experience in authorizations, insurance verification, or healthcare administration, preferably in home health or personal healthcare services.
• Strong understanding of insurance payer requirements and healthcare authorization processes.
• Excellent organizational and time management skills with the ability to prioritize tasks.
• Strong verbal and written communication skills.
• Proficient in Microsoft Office Suite and EMR systems.
• Ability to work independently and collaboratively within a team environment.
• Knowledge of Medicaid, Medicare, and private insurance authorization processes highly desirable.