Authorization Specialist

Overview

• Play a vital role in ensuring seamless home care services through accurate authorization and compliance processes.
• Collaborate with interdisciplinary teams to maintain service delivery and regulatory adherence.
• Verify patient eligibility and manage records using advanced healthcare systems.
• Monitor authorization statuses and address discrepancies proactively for uninterrupted care.
• Maintain detailed tracking systems to ensure efficient authorization management.
• Distribute essential documentation to key teams, supporting operational continuity.
• Contribute to a dynamic healthcare environment focused on patient-centered care.

Key Responsibilities & Duties

• Accurately input and maintain patient profiles and authorization data in healthcare systems.
• Obtain, review, and track service authorizations to ensure compliance and accuracy.
• Verify patient eligibility and align records with authorization requirements.
• Generate and analyze reports to identify expiring authorizations and discrepancies.
• Follow up on missing documentation to maintain regulatory compliance.
• Conduct pre-billing reviews and escalate issues to relevant teams.
• Maintain organized tracking systems for authorization statuses and eligibility.
• Collaborate with care coordinators, finance, and nursing teams to distribute necessary documents.

Job Requirements

• Associate of Science (AS) degree with 1–2 years of relevant experience.
• Proficiency in HHAeXchange and familiarity with Medicaid, MLTC, and Medicare processes.
• Strong skills in Microsoft Excel and Outlook for daily operations.
• Experience verifying eligibility in ePACES is highly preferred.
• Bilingual proficiency in Spanish, Russian, or Mandarin is advantageous.
• Detail-oriented with excellent organizational and communication abilities.