Authorization and Compliance Coordinator in Lincoln, Nebraska at AmanaCare LLC

The Authorization and Compliance Coordinator is responsible for overseeing and coordinating all service authorization activities on behalf of clients receiving home and community-based services. This role serves as the primary point of contact with service coordinators from the Department of Veterans Affairs (VA), the Department of Health and Human Services (DHHS), Area Agencies on Aging (AAA) and Long Term Care Insurance companies, ensuring that all service authorizations are obtained, accurately tracked, and renewed in a timely manner to prevent gaps in client care.

Key Responsibilities

Authorization Coordination

• Serve as the primary liaison between the organization and service coordinators at the VA and DHHS for all service authorization matters.
• Request, receive, and process incoming service authorizations for all active clients.
• Review each authorization for accuracy, including dates of service, number of approved service units, and specified Activities of Daily Living (ADLs) to be completed.
• Maintain a comprehensive, up-to-date tracking system for all active authorizations across both VA and DHHS funding sources.
• Communicate authorization details promptly to relevant clinical and administrative staff to ensure service delivery aligns with approved parameters.

Authorization Renewal and Expiration Management

• Monitor expiration dates for all active service authorizations and proactively initiate the renewal process well in advance of end dates.
• Provide timely notification to service coordinators, clients, and internal staff when an authorization is approaching expiration and renewal is needed.
• Coordinate the submission of renewal requests and any required supporting documentation to the VA and DHHS.
• Follow up with agency contacts to ensure renewal authorizations are received without delays that could disrupt client services.
• Escalate unresolved renewal issues to leadership and advocate on behalf of clients to prevent interruptions in care.

Documentation and Compliance

• Maintain organized and accurate records of all authorizations, correspondence, and renewal activity in the client management system.
• Ensure that service delivery documentation aligns with authorized units, ADL tasks, and date ranges on each authorization.
• Identify and resolve discrepancies between authorized services and services delivered, in coordination with billing and clinical staff.
• Assist with audits and reporting related to service authorizations as requested by leadership or funding agencies.

Communication and Relationship Management

• Build and maintain professional, collaborative relationships with VA and DHHS service coordinators.
• Respond promptly to inquiries from service coordinators, clients, and internal staff regarding authorization status.
• Communicate changes in client needs or service plans to the appropriate agency contacts and obtain updated authorizations as needed.
• Participate in meetings with agency partners as required to support client service planning and authorization processes.

Billing Support

• Collaborate with the billing department to ensure service authorizations are accurately reflected in claims submitted to the VA and DHHS.
• Provide billing staff with timely authorization documentation, including approved service units, dates of service, and any mid-authorization changes.
• Assist in resolving billing denials or disputes related to authorization errors, expired authorizations, or unit discrepancies.
• Notify billing staff promptly when authorization renewals are received, amended, or terminated to ensure claims are processed accurately and without delay.
• Generate monthly Share of Cost reports.
• Set up and invoice Long Term Care Insurance companies.

Qualifications

Required

• Associate's or Bachelor's degree in human services, healthcare administration, social work, or a related field; or equivalent professional experience.
• Minimum of 2 years of experience in a healthcare, home care, or social services setting with exposure to service authorizations, billing, or case management.
• Demonstrated knowledge of VA and/or DHHS service authorization processes for home and community-based services.
• Proficiency with electronic health records (EHR) or client management software.
• Strong organizational skills with the ability to manage multiple priorities and deadlines simultaneously.
• Excellent written and verbal communication skills.

Preferred

• Experience working directly with VA service coordinators or DHHS case managers.
• Familiarity with Activities of Daily Living (ADLs) and personal care service delivery models.
• Prior experience in a home care agency or waiver services environment.

Core Competencies

• Attention to Detail — Accurately interprets and records authorization data with a high degree of precision.
• Proactive Communication — Anticipates authorization expirations and communicates clearly with all stakeholders before issues arise.
• Relationship Management — Fosters positive, professional relationships with external agency contacts and internal teams.
• Problem Solving — Identifies and resolves authorization discrepancies and delays in a timely manner.
• Accountability — Takes ownership of authorization tracking and ensures no client experiences a gap in services due to a lapsed authorization.