Authorizations Specialist

Overview

• Support home care operations by ensuring accurate service authorizations and compliance with payer and regulatory requirements.
• Collaborate with intake, clinical, operations, and billing teams for seamless service delivery.
• Maintain accurate patient profiles, service orders, and authorization data in required systems.
• Verify patient eligibility through ePACES and ensure alignment with authorizations.
• Generate and monitor reports for expiring authorizations and escalate discrepancies.
• Track and follow up on missing documentation and maintain detailed spreadsheets.
• Distribute authorization documents to care coordinators, finance, and nursing teams.
• Work on-site Monday through Friday in a collaborative environment.

Key Responsibilities & Duties

• Enter and maintain accurate patient profiles and authorization data in HHAeXchange and CRM systems.
• Obtain, review, and track authorizations to ensure correct service units and timely record updates.
• Verify patient eligibility through ePACES and ensure alignment with service authorizations.
• Generate and monitor reports for expiring authorizations and escalate discrepancies.
• Track and follow up on missing M11Q documentation and maintain detailed spreadsheets.
• Conduct weekly pre-billing report reviews and escalate discrepancies.
• Distribute authorization documents to care coordinators, finance, and nursing teams.
• Collaborate with intake, clinical, operations, and billing teams for seamless service delivery.

Job Requirements

• Associate of Science (AS) degree required, with 1–2 years of relevant experience.
• Hands-on experience with HHAeXchange and proficiency in Microsoft Excel and Outlook.
• Strong knowledge of Medicaid, MLTC, Medicare authorization processes, and M11Q forms.
• Experience verifying eligibility in ePACES and maintaining detailed records.
• Bilingual proficiency in Spanish, Russian, or Mandarin is a plus.
• Ability to work on-site and collaborate effectively with cross-functional teams.
• Detail-oriented with strong organizational and analytical skills.