POSITION SUMMARY

The Insurance Authorization Lead directs the team responsible for all aspects of payer authorization. This role demands deep knowledge of payer requirements, strong leadership skills, and meticulous attention to detail to ensure every patient's services are appropriately covered from admission through discharge.

ESSENTIAL RESPONSIBILITIES AND DUTIES INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING

Leads, trains, and mentors the authorization team, managing workload distribution and performance to meet departmental metrics and deadlines. Oversees the timely and accurate submission and tracking of all initial insurance authorization requests for home health and hospice patients. Works closely and effectively with the scheduling teams to coordinate start of care and ensure clinical services are only delivered after authorization is confirmed. Directs the process for obtaining authorization following the 485 (Plan of Care) submission and managing all add-on insurance authorizations when required for changes in the patient's plan of care (e.g., increased visits, new services). Establishes and monitors the process for the team to re-verify eligibility on the 1st and 5th of each month for all active patients to proactively identify and resolve any changes in insurance status. Serves as the escalation point for complex authorization denials or issues, communicating directly with various insurance carriers. Ensures all authorization processes are compliant with payer contracts and regulatory standards. Generate reports on authorization status, denial rates, and turnaround times. Other appropriate services and special projects as assigned. The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

QUALIFICATIONS & REQUIREMENTS FOR THE POSITION

At least three (3) years of dedicated experience in insurance verification and authorization, specifically within home health or hospice. At least one (1) year of leadership or supervisory experience managing a healthcare authorization or financial services team. Expert knowledge of Medicare, Medicaid, and commercial insurance authorization processes and documentation requirements for episodic and per diem payments. Proficiency in using Electronic Medical Record (EMR) systems and authorization tracking software. The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc.

is available at http:

//www.pennantgroup.com.