Authorization Specialist

Benefits: Health insurance Paid time off Training & development Vision insurance Dental 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. Performance Standard: Measurement Criteria: Responsibility: Obtain initial and ongoing authorizations for skilled nursing, therapy, and other clinical services as required by payers. Performance Standard: Measurement Criteria: Responsibility: Submit documentation to insurance companies to support authorization requests. Performance Standard: Measurement Criteria: Responsibility: Monitor and track authorization status, renewals, and expiration dates. Performance Standard: Measurement Criteria: Responsibility: Communicate authorization approvals, denials, and requirements to clinical staff and administrative teams. Performance Standard: Measurement Criteria: Responsibility: Collaborate with intake, billing, and clinical departments to ensure alignment and accuracy in patient care and billing. Performance Standard: Measurement Criteria: Responsibility: Maintain up-to-date knowledge of payer-specific requirements and changes in insurance regulations. Performance Standard: Measurement Criteria: Responsibility: Document all authorization activities accurately in the electronic medical record (EMR) and/or billing systems. Performance Standard: Measurement Criteria: Responsibility: Resolve insurance-related issues promptly to avoid delays in care or billing interruptions. Performance Standard: Measurement Criteria: Responsibility: Assist in appeals processes for denied authorizations as needed. Performance Standard: Measurement Criteria: Responsibility: Support cross-training initiatives and assist with special projects as assigned Performance Standard: Measurement Criteria: 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 Failure to meet performance expectations may subject the employee to disciplinary action up to and including termination. 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 disabilitie Each BrightStar Care agency is individually owned and operated. Each BrightStar Care® franchise office is independently owned and operated and is an equal opportunity employer. Services may vary by location in compliance with state licensing requirements. #J-18808-Ljbffr