Authorization Manager

Job Description

Job Description

About Elite
Elite Home Health Care is a licensed home care agency that provides professional homecare services in the New York Metropolitan area, Central, and Upstate NY Regions. At Elite, we only hire the most qualified nurses, home health aides and caregivers who are hand-picked based on their skills and capabilities. They are all licensed, insured and cleared with extensive background screening. But most importantly, our caregivers are known for their warmth, attentiveness and reliability. Our main goal is to deliver compassionate, professional, and integrity-centered care to our clients. We work within the community to provide quality home care for individuals in need.  We are committed to providing our clients with the best possible and most compassionate care!

Job Summary
Owns the authorization function end to end and the pre-billing function end to end, along with all reporting mechanisms on both. Manages the authorization coordinator team, works directly with branch managers to review authorized visits, owns overutilization, and oversees temporary authorizations with support from the Authorization Specialist. This role protects revenue integrity — the gap between what is authorized and what is scheduled is this role’s to close.

Essential Duties and Responsibilities: 
I. Authorization — End to End

• Owns the full authorization lifecycle across all payors: new authorizations, reauthorizations, increases, decreases, extensions, retroactive authorizations
• Manages the Authorization Coordinator team and their payor portfolios; ensures full cross-coverage during absences
• Owns authorization tracking, expiration monitoring, and daily payer follow-up as a managed process, not an individual task
• Escalates high-risk cases: imminent expirations, high-hour patients, pediatric and fragile patients, cases at risk of discharge
• Maintains current working knowledge of payor rules — auth duration, units, renewal timelines, required documentation — across the full payor set

II. Pre-Billing — End to End

• Owns the weekly pre-billing authorization review ahead of every billing run
• Compares authorized hours to scheduled hours; identifies and resolves anything that would block claims submission (expired auths, missing units, wrong auth type, wrong dates)
• Owns resolution of billing discrepancies in partnership with Billing
• Accountable for zero billing holds caused by missing or incorrect authorizations

III. Overutilization

• Owns identification and resolution of overutilization — where delivered or scheduled hours exceed authorized units
• Processes and oversees ad-hoc T-auth updates when services exceed authorization
• Reports overutilization patterns by payor and by branch to the Director

IV. Branch Manager Partnership

• Works directly with branch managers to review all authorized visits
• Serves as the authorization-side counterpart to Operations on staffing and scheduling decisions
• Flags to branches where scheduling is running ahead of authorization

V. Temporary Authorizations

• Oversees the temporary authorization process, executed day to day with support from the Authorization Specialist
• Ensures temp auths are converted to permanent authorizations and not left open

VI. Reporting

• Owns all reporting mechanisms on authorization and pre-billing: volumes, turnaround times, expirations, overutilization, billing holds, discrepancy resolution
• Delivers regular reporting to the Director and to leadership

KPI Ownership

• Zero expired home care authorizations
• Zero billing holds due to missing or incorrect authorizations
• Overutilization identified and resolved before billing run
• Pre-billing review completed ahead of every billing cycle

Qualifications and Skills:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

• Supervisory or management experience in a home care, LHCSA, or managed care authorization/billing environment
• Working knowledge of HHAeXchange required; ePaces required
• Familiarity with MLTC, CHHA, and third-party payor authorization processes
• Strong command of revenue cycle and pre-billing mechanics
• Ability to manage a team through high-volume, time-sensitive workflows

Work Environment:
On-site, Office Location

Benefits:

• Medical Insurance
• PTO & Sick Time
• Referral Program

Pay Range:  The hiring range for this position is $80,000-$85,000/Annually . Various factors will determine final compensation such as a candidate’s years of relevant work experience, skills, certifications, and location.

EHCOFF

HouseWorks, LLC and its Family of Companies is an Equal Opportunity Employer. We do not discriminate against race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability or genetic information.

Powered by JazzHR

znW4E7oYf6