PDN Home Health Authorization Specialist

Job Description

Job Description

Benefits:

• 401(k)
• Competitive salary
• Training & development

Job Summary

VitalCare Home Health LLC is seeking an experienced Authorization Specialist to join our growing Home Health team. The Authorization Specialist is responsible for obtaining, tracking, and managing insurance authorizations for skilled nursing and private duty nursing services. This position works closely with physicians, case managers, Medicaid Managed Care Organizations (MCOs), clinical staff, and families to ensure timely authorization approvals and uninterrupted patient care.

Responsibilities

* Submit initial and continued authorization requests.
* Track authorization expiration dates and renewals.
* Verify Medicaid and insurance eligibility.
* Communicate with MCOs regarding authorization status.
* Coordinate with physicians to obtain required documentation.
* Review nursing assessments and physician orders for completeness.
* Monitor pending authorizations and follow up to prevent delays.
* Resolve authorization denials and submit additional documentation when required.
* Maintain accurate documentation in Alora Plus EMR.
* Collaborate with Intake, Clinical Managers, and Scheduling staff.
* Maintain HIPAA compliance and confidentiality.

Preferred Experience

* Home Health or Private Duty Nursing (PDN)
* Virginia Medicaid
* CCC Plus
* DMAS documentation
* Prior Authorization
* Insurance Verification
* Alora Plus EMR (preferred)

Required Qualifications

* Minimum 2 years of Home Health authorization experience.
* Experience with Virginia Medicaid and Managed Care Organizations.
* Strong knowledge of authorization processes.
* Excellent organizational and communication skills.
* Ability to manage multiple authorizations simultaneously.
* Strong computer skills and attention to detail.

Preferred Payers Experience

* Anthem HealthKeepers Plus
* Sentara Health Plans
* Molina Healthcare
* Aetna Better Health of Virginia
* UnitedHealthcare Community Plan

Benefits

* Competitive salary
* 401(k)
* Professional Development Opportunities

Skills

* Prior Authorization
* Home Health
* Medicaid
* Insurance Verification
* Medical Documentation
* EMR
* Alora Plus
* HIPAA
* Microsoft Office
* Customer Service
* Communication
* Time Management
* Attention to Detail
* Problem Solving

Nice-to-Have

* Bilingual (English/Spanish)
* Experience with pediatric skilled nursing
* Experience with ventilator, trach, and G-tube cases
* Experience working with Medicaid waiver programs

Flexible work from home options available.