Authorization Specialist

Elite Home Health Care Authorizations Specialist

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

The Authorizations Specialist plays a critical role in obtaining and managing authorizations for medical services provided to patients. This individual will be responsible for entering authorizations into the system, following up on missing authorizations, and ensuring that all necessary authorizations are obtained before billing. The Authorizations Specialist will work closely with patients, healthcare providers, and insurance companies to facilitate the authorization process efficiently and accurately.

Essential Duties and Responsibilities

• Enter authorizations for medical services into the appropriate systems or databases accurately and promptly.
• Follow up on missing authorizations by contacting patients, insurance companies, and healthcare providers to obtain the necessary documentation.
• Monitor the status of authorizations and follow up with insurance companies and healthcare providers as needed to expedite the approval process.
• Coordinate with the billing department to ensure that all authorized services are billed accurately and in a timely manner.
• Communicate with patients regarding the status of their authorizations and provide assistance with any authorization-related questions or concerns.
• Maintain detailed and accurate records of all authorizations, including documentation of communications and follow-up activities.
• Collaborate with other members of the healthcare team, including physicians, nurses, and administrative staff, to ensure that all authorization requirements are met.
• Stay informed about changes to insurance regulations, policies, and procedures related to authorizations and ensure compliance with relevant guidelines.
• Prepare accurate reports related to patient authorizations and insurance eligibility.
• Review patient eligibility and coordinate follow-up with patients, payers, and internal staff to resolve coverage issues.
• Assist disenrolled patients with the Medicaid re-enrollment process to restore eligibility and maintain access to services.
• Collaborate with internal teams and external agencies to ensure timely resolution of eligibility and authorization matters.
• When needed, visit local Medicaid offices to support the organization and assist patients with enrollment, eligibility, and related documentation.
• Perform other duties as assigned.

Qualifications and Skills

• High school diploma or equivalent required; associate's or bachelor's degree preferred.
• Minimum of 1-2 years of experience in a healthcare-related role, with specific experience in authorizations preferred.
• Strong organizational skills and attention to detail, with the ability to manage multiple tasks and priorities simultaneously.
• Excellent communication skills, both written and verbal, with the ability to interact professionally with patients, healthcare providers, and insurance company representatives.
• Proficiency in using computer systems and software applications, including electronic medical records (EMR) systems and Microsoft Office Suite.
• Ability to work independently with minimal supervision and make sound judgments based on established guidelines and procedures.
• Knowledge of medical terminology, insurance terminology, and billing processes preferred.
• Ability to maintain confidentiality and handle sensitive information with discretion.

Work Environment: On-site Benefits

• Medical Insurance
• PTO & Sick Time
• Referral Program

Pay Range: The hiring range for this position is $29.00-$31.00/hour. Various factors will determine final compensation such as a candidate's years of relevant work experience, skills, certifications, and location. OFFICE001

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.