Authorizations Specialist

Our agency is seeking an experienced and dependable Authorizations Specialist that will be responsible for obtaining, managing, and tracking prior authorizations and insurance verifications for home health services across commercial insurance plans and Medicare. This role serves as a critical liaison between the clinical team, physicians, and payers to ensure timely approval of services and continuity of patient care. The ideal candidate brings hands‑on experience in home health or post‑acute authorizations and a strong understanding of payer requirements. Responsibilities Authorization Management: Initiate, submit, and track prior authorization requests for home health services across commercial insurers, Medicare Advantage, and Medicaid payers. Verify eligibility and benefits prior to start of care; monitor expiration dates and submit renewals proactively to prevent visit gaps. Maintain accurate documentation of all authorization activity (approvals, denials, pending) in the EMR/scheduling system. Clinical Team Coordination: Collaborate with clinicians, schedulers, and intake staff to align authorized visits with care plans and physician orders. Communicate authorization status, payer limitations, and coverage rules to the clinical team in a timely manner; elevate urgent needs for new admissions or changes in condition. Coordinate clinical documentation requests (485s, OASIS, physician orders) to satisfy payer requirements. Payer & Compliance: Maintain working knowledge of CMS home‑health coverage guidelines, PDGM requirements, and MCO/commercial payer authorization processes. Ensure all authorization activity complies with HIPAA, payer contracts, and agency policies; assist with clinical record preparation submitted to payers. Denials & Follow‑Up: Identify, document, and communicate authorization denials to clinical and billing teams; support the appeals process by gathering documentation and drafting summaries. Track denial trends and report patterns to supervisors for ongoing process improvement. Qualifications High school diploma or GED required; associate’s or bachelor’s degree in Healthcare Administration, Business, or a related field preferred. Minimum 2 years of prior authorization experience in home health, hospice, or post‑acute care setting required. Demonstrated experience working with commercial insurers. Familiarity with Medicare Advantage authorization processes and PDGM visit utilization strongly preferred. Proficiency with EMR/scheduling systems and payer online portals. Strong understanding of home health insurance terminology, CPT/revenue codes, and coverage criteria. Excellent organizational skills with the ability to manage multiple active cases and deadlines simultaneously. Clear written and verbal communication skills; comfortable interfacing with clinical staff, physicians’ offices, and payer representatives. Detail‑oriented with strong follow‑through and documentation habits. Benefits Health, vision and dental insurance. Paid time off. Paid holidays. This role requires a Level 2 background screening in compliance with Florida AHCA regulations prior to employment. #J-18808-Ljbffr