Intake and Eligibility Coordinator

Intake Eligibility Coordinator 

Job Summary

The Intake & Eligibility Coordinator is a critical linchpin in ensuring the financial and operational stability of the home services department. This role is primarily responsible for the meticulous management and verification of client insurance eligibility and authorizations. By proactively monitoring, renewing, and tracking all insurance-related data, the Coordinator ensures seamless, uninterrupted client care and enables the agency to bill accurately for services rendered. This position requires a high level of detail orientation, proactive communication, and expert navigation of various insurance portals. Furthermore, this role provides essential support and serves as a key resource for many of the departments within Home Services.

Responsibilities

1. Eligibility Verification & Management:

• Conduct daily verification of insurance eligibility for all new and existing clients using a variety of portals (PSS, Availity, CountyCare, Meridian, Aetna, VA/Optum, Humana, Molina).
• Capture and upload proof of eligibility (screenshots) to each client's document profile inAxisCare.
• Maintain and meticulously update the master Eligibility Spreadsheet withaccurateclient data, including insurance IDs, authorization dates, and status flags (Active, Inactive,Terminated, Disenrolled).
• Execute changes in the tracking system when a client's insurancechangesor they are disenrolled.

1. Authorization Management & Renewal:

• Proactively manage the entire authorization lifecycle to prevent service gaps.
• Run monthlyexpirationreports fromAxisCaretoidentifyauthorizations expiring in the following month.
• Initiate renewal requests with payers one month in advance, with a goal of completing all requests for the upcoming month at least one week prior to the month beginning.
• Streamline the renewal process byconsolidatingrequests: Compile all expiring authorizations for a singleIDoACare Coordination Unit (CCU) onto one master spreadsheet andsubmitvia a single email.
• Apply a similarconsolidatedapproach for MCOs with standard renewal cycles (e.g., Aetna’s 3-month authorizations).
• Provide necessary client information and documentation with each request. Process and keeprecordof IDOA/IDHS fax requests, manage confirmation pages.
• Diligently track all renewal requests and conduct systematic follow-ups with payers until the renewed authorization is received.

1. Disenrollment Process Management:

• Proactivelyidentifyand manage the client disenrollment process from start to finish upon notification or as discovered through routine eligibility checks.
• Ensure all disenrollments and MCO roll-offs are processed ina timelyfashion to prevent billing issues and service gaps.
• Verify the client's new insurance via the PSS portal andinitiatethe authorization request with the new provider.
• Notify the Billing department, relevant Branch Manager, and Quality Control of the insurance change to ensure billing and service continuity.
• Accurately update the Disenrollment and Eligibility spreadsheets to reflect the transition.

1. Communication, Collaboration & Documentation:

• Serve as the central communication hub for eligibility and authorization statuses between insurance providers, Case Managers, and internal teams.
• Provide direct support to the billing team, and branches by verifying insurance andassistingwith authorization-related issues for referrals.
• Maintain impeccable andtimelydocumentation in Client Notes,AxisCare, and all tracking spreadsheets (Eligibility, Authorization, Disenrollment) for every action and communication.
• Communicate proactively with branches, sending monthly reports on expiring VA authorizations.

1. Problem-Solving & Departmental Support:

• Investigate and resolve authorization issues, such as missing start dates or incorrect provider information, by contacting insurers directly.
• Assist Case Managers by contacting clients to encourage attendance at redetermination appointments.
• Process and verify service extension requests from branchesin accordance withpayer-specific guidelines (3 months for MCOs/DORS; 12 months for IDOA).
• Provide support to the BillingDepartmentto resolve eligibility-related billing denials.

Required Skills/Abilities

• Proficient in Microsoft Office applications (Word, Excel, Outlook).
• The ability to type and file accurately.
• Excellent communication and organizational skills.
• Good telephone etiquette.

Education and Experience

• High school diploma or GED.
• Proven experience working in a medical office.
• Working knowledge of medical terminology and medical insurance plans.

Physical Requirement

• Prolonged periods sitting in a desk and working on a computer