Job Description

The Remote Home Health Authorization Specialist is responsible for obtaining, tracking, and maintaining prior authorizations for home health services in compliance with payer requirements. This role works closely with intake, clinical staff, physicians’ offices, and insurance providers to ensure timely approval of services, minimize delays in care, and support accurate reimbursement.

Key Responsibilities

Authorization & Payer Coordination

• Obtain prior authorizations and re-authorizations for home health services (Skilled Nursing, PT, OT, ST, HHA, MSW, etc.).
• Verify insurance eligibility, benefits, and authorization requirements for commercial, Medicare Advantage, and Medicaid plans.
• Submit complete authorization requests with required clinical documentation within payer timelines.
• Track authorization status and follow up with payers until determinations are received.
• Communicate authorization approvals, denials, and limitations to intake and clinical teams.

Documentation & Compliance

• Ensure all authorizations are accurately documented in the EMR/system.
• Maintain compliance with payer contracts, state regulations, and agency policies.
• Monitor authorization expiration dates and initiate renewals to prevent service disruption.
• Support audits by providing authorization documentation as requested.

Collaboration & Communication

• Work closely with clinicians to obtain clinical notes, orders, and supporting documentation.
• Communicate with physician offices regarding orders and authorization requirements.
• Serve as a liaison between the agency and insurance companies.
• Respond promptly to internal and external inquiries regarding authorization status.

Denials & Appeals Support

• Identify authorization denials or partial approvals.
• Assist with gathering documentation for appeals when applicable.
• Escalate complex authorization issues to leadership as needed.

Requirements

Required Qualifications

• High school diploma or equivalent
• Minimum 2 + years’ experience in home health, healthcare authorization, intake, or insurance verification.
• Knowledge of prior authorization processes for home health services
• Familiarity with Medicare Advantage, Medicaid MCOs, and commercial payers.
• Strong attention to detail and ability to manage multiple authorizations simultaneously.
• Proficient in EMR systems ( Kinnser/Wellsky) and Microsoft Office (Outlook, Word, Excel).
• Reliable high-speed internet and private, HIPPA-compliant workspace

Skills & Competencies

• Strong organizational and time-management skills
• Clear written and verbal communication
• Problem-solving and follow-up driven mindset
• Ability to work independently and as part of a team
• Professional phone etiquette and customer service skills

Work Environment

• Fully remote, home-based role
• Standard business hours aligned with operations
• May require coordination across time zones