Job Description

Job Title: Insurance Authorization Specialist Department: Eligibility & Authorization Reports To: SVP of Patient Care Coordination Position Type: Full-Time

GENERAL SUMMARY

The Insurance Authorization Specialist is responsible for obtaining and verifying insurance authorizations for all home health and hospice services provided by the agency. This role ensures timely and accurate processing of authorizations, facilitates the appeals process when necessary, and works closely with clinical and administrative teams to support optimal patient care and service delivery.

ESSENTIAL DUTIES

1. Verify patient insurance coverage and eligibility for home health and hospice services.
2. Obtain prior authorizations and re-authorizations from private insurers, Medicare Advantage plans, and Medicaid as required.
3. Maintain accurate and up-to-date records of insurance authorizations in Home Care Home Base (HCHB).
4. Communicate with physicians offices, insurance companies, and internal departments to coordinate and secure timely authorizations.
5. Initiate and track appeals for denied or delayed authorizations.
6. Educate internal staff on payer-specific authorization requirements and updates.
7. Work collaboratively with intake, billing, and clinical teams to prevent delays in patient care.
8. Follow up on pending authorizations to ensure continuity of services.
9. Comply with HIPAA regulations and agency policies regarding patient information and documentation.
10. Participate in weekend and holiday coverage rotations as assigned.
11. Other duties as assigned.

SPECIAL SKILLS AND ABILITIES REQUIRED

Strong understanding of the insurance authorization and appeals process. Proficient in using electronic medical records (EMR) and insurance portals. Excellent verbal and written communication skills. Strong attention to detail, organizational skills, and the ability to prioritize workload. Ability to work independently and as part of a team in a fast-paced environment.

EDUCATION

High school diploma or equivalent required

EXPERIENCE

Minimum 1 year of experience in insurance verification and authorization, preferably in a home health or hospice setting.

CORE COMPETENCIES

Build credibility and trustCollaborate with othersDemonstrate interpersonal understanding and utilize effective communication skillsDeliver resultsAnalyze problems and make sound decisionsDemonstrate resilience under pressureCommit to continuous learning and improvement

DEGREE OF TRAVEL

None

Job Tags

Permanent employment, Full time, Weekend work,

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