Pediatric Insurance Authorization Specialist

JJob Title: Pediatric Insurance Authorization Specialist

Job Description:

The Eligibility Coordinator position focuses on managing tasks related to pediatric patient

authorization requests and eligibility verification. The role emphasizes system updates,

scheduling, documentation, and coordination to ensure efficient healthcare service operations,

with a strong focus on securing and maintaining accurate authorizations and confirming member

eligibility.

Key Responsibilities:

A. Office & Administrative Support

1. Oversee daily office operations, including answering phones, operating office

machines, and maintaining organized filing systems.

2. Coordinate outgoing mail: gather, prepare, and send documents as needed for

internal and external communications.

B. Authorization Management

1. Actively manage and track submitted authorization requests for pediatric patients to

ensure timely approvals.

2. Communicate with insurance providers, healthcare facilities, HHAExchange, and

internal teams to resolve issues or delays.

3. Maintain accurate and current authorization details in the OneTime system,

including status updates, coverage specifics, schedules, and amendments.

4. Cross-reference data with source documents to ensure accuracy and compliance.

5. Monitor expiration dates and proactively submit renewal requests to prevent

coverage lapses.

C. Eligibility Verification

1. Regularly review provider portals to confirm member eligibility for benefits before

services are scheduled.

2. Cross-check data across platforms (insurance portals, OneTime, HHAExchange) to

identify and correct discrepancies.

3. Resolve issues by collaborating with insurance representatives and internal billing

teams, documenting all actions for compliance.

4. Maintain updated eligibility records in OneTime to reflect accurate coverage.

5. Escalate unresolved or complex eligibility cases to the Nursing Supervisor or

Operations Manager with a summary of findings and attempted resolutions.

D. Patient Scheduling & Staffing

1. Create and maintain pediatric patient schedules in OneTime based on authorization

requirements.

2. Coordinate and assign field staff according to patient care needs and authorized

service parameters.

E. Missed Visit Reporting

1. Review payroll specialist notes to identify missed visits from the previous week.

2. Enter accurate data into weekly Missed Visit reports for submission to insurance

providers, ensuring transparency and compliance.

F. Document & Physician Coordination

1. Monitor and organize incoming documents; file accurately in patient charts to

maintain complete records.

2. Track and manage Form 485 processing, including submission timelines and follow-

up.

3. Coordinate with physicians for required documentation: fax forms, follow up on

signatures, and maintain communication logs.

4. Track documents needing MD review or approval to ensure timely completion and

proper documentation.

Qualifications:

1. Previous experience in healthcare administration or a related field preferred.

2. Related Skills: Familiarity with healthcare processes, patient management, and

administrative workflows.

3. Strong organizational skills and attention to detail.

4. Related Skills: Time management, multitasking, and the ability to handle complex

information.

5. Proficiency in using healthcare management systems (e.g., OneTime, HHAExchange,).

6. Related Skills: Technical proficiency, ability to adapt to new systems, and understanding

of data management.

7. Excellent communication skills for coordinating with internal and external stakeholders.

8. Related Skills: Interpersonal skills, effective written and verbal communication, and the

ability to convey information clearly.

9. Ability to work independently and prioritize tasks effectively.

10. Related Skills: Self-motivation, decision-making, and efficient task prioritization.

11. Ability to obtain and maintain departmental information in an organized and easily

accessible manner.

12. Related Skills: Data organization, record-keeping, and proficiency in information

management tools.

13. Participate in Quality Management Meetings.

14. Related Skills: Analytical skills, problem-solving, and the ability to contribute to quality

improvement initiatives.

Job Types: Part-time, Contract, Temporary, Internship

Pay: $17.00 - $18.00 per hour

Expected hours: 40 per week

Work Location: In person

Salary : $17 - $18