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 active coverage and approved authorizations throughout the patient care cycle, supporting revenue integrity.
• Collaborate with care managers, intake, scheduling, and billing teams to resolve authorization issues.
• Maintain accurate documentation of eligibility verifications and communications using industry-standard tools.
• Stay updated on Medicaid, MLTC, and third-party payer policies to ensure compliance.
• Provide support to patients and families regarding eligibility-related inquiries and resources.
• Generate detailed reports on authorization and eligibility for operational and billing purposes.
• Operate in a fast-paced environment with opportunities for professional growth and learning.

Eligibility and Authorization Coordinator Key Responsibilities & Duties

• Verify Medicaid eligibility and enrollment using ePACES, payor portals, and other tools.
• Submit and monitor service authorization requests with Medicaid and third-party payers.
• Track authorization dates and utilization to prevent coverage lapses.
• Communicate authorization status and issues with relevant stakeholders.
• Maintain documentation of eligibility verifications and communications in HHAeXchange.
• Identify and escalate risks related to eligibility and authorization processes.
• Support patients and families with eligibility-related questions and resources.
• Generate reports for operations and billing teams to ensure compliance and efficiency.

Eligibility and Authorization Coordinator Job Requirements

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