Benefits:
Dental insurance
Health insurance
Paid time off
Vision insurance
Purpose of the Role
The Authorization Specialist is responsible for ensuring timely and accurate insurance verifications and obtaining authorizations for home health services. This role is critical in facilitating seamless patient care by securing required approvals and communicating effectively with insurance providers, clinical staff, and patients.
Key Responsibility Areas (KRAs)
Responsibility: Verify patient insurance benefits and eligibility for home health services.
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Responsibility: Obtain initial and ongoing authorizations for skilled nursing, therapy, and other clinical services as required by payers.
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Responsibility: Submit documentation to insurance companies to support authorization requests.
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Responsibility: Monitor and track authorization status, renewals, and expiration dates.
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Responsibility: Communicate authorization approvals, denials, and requirements to clinical staff and administrative teams.
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Responsibility: Collaborate with intake, billing, and clinical departments to ensure alignment and accuracy in patient care and billing.
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Responsibility: Maintain up-to-date knowledge of payer-specific requirements and changes in insurance regulations.
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Responsibility: Document all authorization activities accurately in the electronic medical record (EMR) and/or billing systems.
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Responsibility: Resolve insurance-related issues promptly to avoid delays in care or billing interruptions.
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Responsibility: Assist in appeals processes for denied authorizations as needed.
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Responsibility: Support cross-training initiatives and assist with special projects as assigned
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Core Competencies & Behaviors
Accuracy & Detail Orientation: Carefully reviews payer requirements and inputs data with precision
Communication: Clearly conveys complex insurance information to staff and payers
Customer Focus: Provides responsive support to internal teams and patients regarding coverage issues
Adaptability: Responds effectively to frequent changes in payer guidelines and agency procedures
Teamwork: Works collaboratively with intake, billing, and clinical teams to coordinate patient care
Accountability: Follows through on open tasks and meets timelines for authorizations
Education and Experience
High school diploma or equivalent required; associate’s degree preferred
Minimum 2 years of experience in insurance verification or authorization, preferably in home health or healthcare setting
Knowledge of commercial payer authorization processes
Experience using EMR or home health software systems
Familiarity with HIPAA and healthcare documentation standards
Review Cycle & Feedback
Failure to meet performance expectations may subject the employee to disciplinary action up to and including termination.
Working Conditions & Physical Requirements
This position operates in a professional office environment. The employee routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets. The role primarily involves sedentary work, including prolonged periods of sitting, frequent use of hands for typing, and regular communication via phone and email. Minimal lifting of materials (typically under 10 pounds) may occasionally be required.
Regular, predictable attendance is required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.