Job Description

The Eligibility & Authorization Specialist is responsible for verifying patient insurance benefits and obtaining, tracking, and maintaining required authorizations for home health services. This position works closely with Intake, Revenue Cycle, agency staff, and payer representatives to ensure patients are financially cleared for services and that required authorizations are obtained and maintained throughout the episode of care. The ideal candidate is highly organized, detail-oriented, comfortable working with multiple payer portals, and able to manage a high volume of patients while meeting time-sensitive deadlines.

Home Health Authorization experience is preferred.

Requirements

• Verify insurance eligibility and benefits for new and existing home health patients.
• Confirm coverage for home health services, including applicable disciplines, visit limitations, copays, deductibles, coinsurance, and other patient financial responsibilities.
• Obtain initial and ongoing authorizations for skilled nursing, physical therapy, occupational therapy, speech therapy, home health aide, and other covered home health services.
• Submit authorization requests through payer portals, fax, phone, or other required methods.
• Gather and submit required clinical documentation to support authorization requests.
• Track authorization status and follow up with payers on pending requests.
• Maintain accurate authorization dates, approved disciplines, visit quantities, authorization numbers, and other requirements within the EMR.
• Request extensions or additional visits timely to prevent interruptions in patient care.
• Communicate authorization approvals, limitations, denials, and outstanding requirements accordingly.
• Research and resolve eligibility discrepancies, authorization issues, and payer-related barriers.
• Maintain knowledge of payer-specific requirements and changes in authorization processes.
• Document all payer communications and authorization activity accurately and timely.
• Assist with identifying potential authorization-related billing issues before claims are submitted.
• Maintain patient confidentiality and comply with HIPAA and all applicable company policies and procedures.
• Perform other related duties as assigned.

Benefits

What We Offer-Our Work/Life Balance

• A workplace where your ideas and voice actually matter
• Supportive leadership
• Competitive salary
• Health, dental, vision insurance
• 3 Weeks Paid Time Off & Holiday Pay
• Health, Vision, Dental Benefits
• 401K plus Employer Contribution
• Voluntary Life Insurance
• Critical Illness, Group Hospital Indemnity, Accident Insurance