Authorization Specialist

Authorization Specialist

Reporting to the Area Vice President, AVP, or the Regional Business Office Manager, RBOM, an Authorization Specialist ensures patients receive timely and authorized healthcare services. The position involves a blend of administrative tasks, customer service, and knowledge of insurance coordination of benefits.

Key Responsibilities:

• Verifies insurance coverage and documents benefit maximums for all home health services in the medical record.
• Secures prior authorization from insurance companies and documents approval details appropriately in the EHR system.
• Collaborates daily with branch staff, insurance companies, and patients as needed to ensure a smooth authorization process.
• Addresses issues related to denials, discrepancies, and incomplete information in a timely manner.
• Remains abreast of changes in insurance, prior authorization requirements, and policies with contracted insurance companies.

Minimum Education Required: High School Diploma or equivalent.

Minimum Experience Required: Applicants should possess a minimum of two years prior experience in obtaining medical authorizations.

Knowledge, Skills, Abilities:

• Must have proficient working knowledge of a computer and all Microsoft Office products.
• Successful candidates possess strong communication, organizational and time management skills to function effectively in a fast-paced environment with multiple priorities.
• Knowledge and understanding of Medicare, Medicaid, Private Pay and Third Party reimbursement.