Eligibility And Authorization Coordinator

Eligibility and Authorization Coordinator Overview

• The Eligibility and Authorization Coordinator oversees Medicaid eligibility verification and service authorization processes for uninterrupted patient care.
• Ensure patients maintain active coverage and approved authorizations throughout their care journey.
• Collaborate with care managers, insurance plans, intake, scheduling, and billing teams.
• Utilize tools like ePACES, HHAeXchange, and payer portals for eligibility verification.
• Track authorization timelines and utilization to prevent coverage lapses.
• Provide support to patients and families regarding eligibility-related inquiries.
• Stay updated on Medicaid, MLTC, and third-party payer policies.
• Generate reports on authorization and eligibility for operational insights.
• Contribute to maintaining revenue integrity and operational efficiency.

Eligibility and Authorization Coordinator Key Responsibilities & Duties

• Verify Medicaid eligibility and enrollment using ePACES and other tools.
• Submit and monitor service authorization requests with various payers.
• Track authorization timelines and prevent coverage lapses.
• Maintain accurate documentation in HHAeXchange.
• Communicate effectively with internal teams and external payers.
• Identify and escalate risks related to eligibility and authorization.
• Support patients and families with eligibility-related concerns.
• Generate reports for operations and billing teams.
• Stay informed about relevant policies and requirements.

Eligibility and Authorization Coordinator Job Requirements

• High school diploma or equivalent required; associate’s or bachelor’s degree preferred.
• Minimum 3 years of experience in Medicaid, MLTC, or healthcare authorization.
• Proficiency in ePACES, payer portals, and HHAeXchange.
• Strong knowledge of NY Medicaid, MLTC, and related programs.
• Excellent communication and follow-up skills.
• Ability to manage multiple priorities and meet deadlines.
• Attention to detail and accuracy in documentation.
• Bilingual proficiency in Spanish, Russian, or other languages is a plus.
• Demonstrated sensitivity to diverse patient populations and cultural preferences.