Medicaid EligibilityAuthorization Coordinator Sunshine Homecare Services

POSITION: Medicaid Eligibility / Authorization Coordinator

REPORTS TO: Controller

POSITION SUMMARY

At Sunshine Homecare Services we believe access to quality care begins with compassion accuracy and advocacy. We are seeking a dedicated Medicaid Eligibility / Authorization Coordinator who is passionate about supporting patients and families by ensuring uninterrupted insurance coverage and timely authorizations.

This role is vital to our mission serving as a key liaison between patients families payers and internal teams. The Coordinator ensures that eligibility authorizations and compliance requirements are met so our clients can receive care without delay across all Sunshine Homecare agencies.

QUALIFICATIONS

1. Bachelors Degree with 35 years of experience in Medicaid eligibility and authorization management within a healthcare setting including acquiring and maintaining authorizations for Medicaid and other insurance plans.

2. Knowledge of NHTD and TBI program requirements and regulations is a plus.

3. Experience working directly with patients family members service coordinators Medicaid representatives and insurance companies.

4. Ability to read write and comprehend instructions short correspondence and memos; ability to draft professional written communications.

5. Strong verbal communication skills with the ability to effectively present information in one-on-one and small-group settings.

6. Proficiency in office equipment and computer applications including Microsoft Word and Excel.

7. Strong organizational interpersonal and time-management skills.

8. Ability to apply common-sense reasoning to carry out instructions and resolve routine issues.

9. Ability to manage standardized processes with occasional variables in a fast-paced environment.

CONTACTS

External Contacts:

• Patients and patient families

• Service coordinators

• Medicaid representatives

• Insurance companies

• Outside billing vendors

Internal Contacts:

• Administrative staff

• Intake team

• Finance department

EQUIPMENT USED

• Computer

• Telephone

• Copier

• Fax machine

SPECIFIC DUTIES AND RESPONSIBILITIES (ADA ESSENTIAL FUNCTIONS)

In compliance with the Americans with Disabilities Act (ADA) essential job functions are identified below. A duty is considered essential if the position exists to perform that duty requires specialized skills or can only be performed by a limited number of employees.

Confirm patient insurance coverage and eligibility for services prior to admission and before services are rendered.

Obtain initial and ongoing authorizations from Medicaid and insurance companies ensuring all required documentation is submitted accurately and timely.

Serve as a liaison between patients families insurance representatives service coordinators and clinical staff to facilitate the authorization process and resolve issues.

Gather and submit all required documentation for patients enrolled in NHTD and TBI programs.

Track patient eligibility status and ensure continuous enrollment to prevent service interruptions.

Submit required documentation to Medicaid for fee-for-service patients including pediatric cases.

Develop and maintain a tracking system for expiring authorizations reviewing weekly to prevent lapses that may result in non-payment.

Follow up on outstanding authorization requests to ensure timely determinations and continuity of care.

Provide clear information and support to patients and families regarding insurance coverage and authorization processes promoting a positive patient experience.

Maintain accurate and compliant records of all authorization requests approvals and denials in accordance with regulatory and internal policies.

Perform other duties as assigned by the Controller.

CUSTOMER SERVICE & INTERPERSONAL SKILLS

• Assists team members as needed

• Demonstrates cooperation and professionalism with patients families supervisors and colleagues

• Maintains a friendly respectful and professional work environment

• Accepts constructive feedback and adjusts performance accordingly

• Uses established communication channels effectively

• Respects individuals and seeks assistance appropriately when needed

SPECIALIZED SKILLS & TECHNICAL COMPETENCIES

• Proficiency in ePACES and electronic eligibility systems

• Experience with HHA Exchange preferred

• Strong telephone and customer service skills

• Word processing and spreadsheet management

• Accurate data entry skills

PHYSICAL DEMANDS

The physical demands described below are representative of those required to perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

Sedentary Work:
Exerting up to 10 pounds of force occasionally and/or negligible force frequently. This position involves prolonged periods of sitting and extended computer use.

ADDITIONAL INFORMATION

Essential job duties listed indicate the minimum level of knowledge skills and/or abilities deemed necessary to perform the job competently. Job descriptions are an overview of the task responsibilities and requirements of the position. Employees may be required to perform other job-related assignments as requested.

Sunshine Homecare Services is an equal opportunity employer. Sunshine Homecare Services is committed to providing access equal opportunity and reasonable accommodation for individuals with disabilities in employment its services programs and activities. To request reasonable accommodation contact Joanne DiBiasi of Human Resources at Ext 2213

Sunshine Homecare complies with all applicable federal state and local laws regarding background checks including the Fair Credit Reporting Act (FCRA). We will obtain your written consent before conducting any background check and will provide you with a copy of the report if requested.

We are committed to complying with all applicable laws and regulations regarding background checks. We will obtain your written consent before conducting any background check and will ensure that the information obtained is used in a fair and lawful manner.

Required Experience:

IC