Authorization Specialist - Home Care Agency

Responsibilities:

Process and track authorizations for home health services, ensuring timely submission to insurance providers.
Review patient records and treatment plans to ensure all required documentation is complete and accurate.
Communicate with insurance companies to secure necessary authorizations for services.
Communicate with insurance companies regarding revised authorizations (fax time/sheets) and other requested documents.
Manage and resolve issues related to denied or delayed authorizations, including re-submissions or appeals.
Maintain detailed and accurate records of all authorization activities.
Collaborate with clinicians, case managers, and other team members to ensure care plans align with authorization requirements.
Stay updated on changes in insurance policies, billing codes, and regulatory requirements related to home care.
Provide exceptional customer service to both internal and external stakeholders, ensuring clear and efficient communication.
Weekly review of admissions, discharges, and temp auth reports
Monitor payer Portals and follow up branch / Intake’s requests
Notify the teams of changes in authorization e.g. Termination, Holds, Hospitalizations, Increases and Decreases.
Verify Eligibility the first business day of the month and the 15th for flagged known potential issues, Reach out to all insurances Via email/phone regarding potential termination or continuations of services.
Monitor the HHAEX Board (Accept or Deny cases)
Monitor/review Payor messages on the Home screen, update HHAEX and advise Placement of any changes accordingly.
Run Reports from HHAEX (Temp Report, Authorizations due by Date Report, Authorizations Report)
Create Profiles for New members in HHAEX.
Merge profiles so all Clinical Documents are kept in one place.
Monitor Mail (some contracts still send authorizations via mail)

Qualifications:

Must have a minimum of 1 year experience working in an Authorizations related role in a Home Care agency.  
Proficiency with HHA eXchange.
Proficiency with Excel.
Strong organizational, critical thinking, and problem-solving skills with attention to detail.
Must be able to take initiative, initiate appropriate follow-up with others and related to completing task thoroughly and accurately.
Effective communication and interpersonal skills, enabling you to build rapport with clients, caregivers, and healthcare professionals.   
Ability to work in collaborative environment across departments

Education:

High school diploma or equivalent required.