Authorization Specialist

Overview

• Support home care operations by ensuring timely and accurate authorization of services and compliance with payer and regulatory requirements.
• Collaborate with intake, clinical, operations, and billing teams to maintain seamless service delivery and accurate records.
• Verify patient eligibility and maintain updated records in HHAeXchange and CRM systems.
• Generate and monitor reports for expiring authorizations and escalate discrepancies as needed.
• Track and follow up on missing documentation to ensure compliance and service continuity.
• Maintain detailed spreadsheets of pending authorizations and eligibility statuses for efficient tracking.
• Distribute authorization documents to relevant teams, including care coordinators, finance, and nursing staff.

Key Responsibilities & Duties

• Enter and maintain accurate patient profiles and authorization data, including service orders, diagnosis codes, and case documentation.
• Obtain, review, and track authorizations to ensure correct service units and timely record maintenance.
• Verify patient eligibility through ePACES and ensure alignment with authorizations.
• Generate and monitor HHAeXchange reports for expiring authorizations and escalate discrepancies.
• Track and follow up on missing M11Q documentation to ensure compliance.
• Conduct weekly pre-billing report reviews and escalate discrepancies as needed.
• Maintain detailed spreadsheets of pending authorizations and eligibility statuses for efficient tracking.
• Distribute authorization documents to care coordinators, finance, and nursing teams.

Job Requirements

• Associate of Science (AS) degree required, with 1–2 years of relevant experience.
• Hands-on experience with HHAeXchange is mandatory for this role.
• Strong knowledge of Medicaid, MLTC, and Medicare authorization processes.
• Proficiency in Microsoft Excel and Outlook is essential for daily tasks.
• Experience verifying eligibility in ePACES is highly preferred.
• Bilingual proficiency in Spanish, Russian, or Mandarin is a plus.
• Detail-oriented with strong organizational and communication skills.