Authorization Specialist Lead II (Prebilling, Insurance, Payor Contracts) - HomeCare

Hartford Healthcare•Farmington, CT

2d•Hybrid

About The Position

Hartford HealthCare at Home, the largest provider of homecare services in Connecticut, is seeking an Authorization Specialist Lead II. This role supports the Prebilling and Authorization Manager in training, payor updates, and identifying metrics related to eligibility and authorizations. The specialist ensures accurate and timely processing of patient insurance verifications and prior authorization requests by reviewing information, resolving complex cases, and maintaining quality standards within established payor guidelines. The position requires strong knowledge of payor contracts, insurance authorization requirements, and excellent communication skills to interact effectively with branches, team members, and payors. Responsibilities include verifying insurance eligibility and authorization for Home Health and Hospice clients, focusing on accuracy and productivity, and communicating information to relevant parties. The role is part of a fully remote team with potential for onsite work as needed, and involves interpreting insurance specifics and assisting with training and quality assurance reviews.

Requirements

Strong knowledge of payor contracts
Strong knowledge of insurance authorization requirements
Excellent communication skills to effectively interact with branches, team members, and payors
Ability to work independently as well as within the Team environment
High School Diploma
One year of experience within a healthcare setting and familiarity with payor sources and processes
Strong written and verbal English communication skills
Knowledge of third party payor regulations including Medicare, Assistance, Veterans Affairs (VA) and private insurance
Ability to promote and maintain a positive attitude and encourage others to do the same
Strong organizational skills and the ability to work independently with minimal supervision
Demonstrates ability to make appropriate judgements as it relates to the payor authorization process
Basic computer skills with the ability to learn new software

Nice To Haves

Two – four years’ experience within a healthcare setting and familiarity with payor sources and processes
Knowledge of Word and Excel

Responsibilities

Supporting the Prebilling and Authorization Manager in training, payor updates and identifying metrics around eligibility and authorizations
Ensuring accurate and timely processing of patient insurance verifications and prior authorization requests
Reviewing submitted information, resolving complex cases, and maintaining quality standards within the established payor guidelines
Verify insurance eligibility and authorization requirements for Home Health and Hospice clients in a timely manner according to payor specific guidelines
Communicate payor eligibility and authorization information to all necessary parties within the department and branch
Interpret insurance specifics and recognize how to enter information correctly
Assists Prebilling and Authorizations Manager in identifying QARs (Quality Assurance Reviews) upon request
Identify inaccuracy within accounts leading to possible bad debt
Assist in additional training and support with other Authorization Specialists upon request from Prebilling and Authorizations Manager
Verifies insurance eligibility and requests authorization of current and potential home care clients in an accurate and timely manner
Communicates payor authorization and eligibility information to Clinical Manager, Business Manager or designee
Enters insurance authorization and eligibility information according to payor specific guidelines
Notifies branches regarding lack of payor coverage or other service non-coverage issues
Performs re-authorization and eligibility checks in a timely manner
Communicates and documents information regarding change in authorization and eligibility to branch management
Monitors and ensures all client authorization of services are current and quantity and type of services provided meet payor requirements
Reviews and ensures appropriate processing of authorizations
Sends informational correspondence to payor
Maintains professional, positive and effective communication with payors, clients, Corporate and branch employees
Maintains confidentiality of all information pertaining to clients, families, and employees
Consults with branch management and clinical employees
Participates in the after hours on-call process to assure client care policies and procedures are followed and staffing issues are resolved on a rotation basis
Performs other related duties and responsibilities as assigned by Prebilling and Authorizations Manager
Establishes performance expectations of staff, coaches, develops, and mentors by evaluating performance
Leads workflows to ensure maximum productivity and quality standards
Keeps Revenue Cycle resources and other key leaders in the OSO apprised of problems/concerns/delays within authorization department on a timely basis
Stays up to date with industry trends and best practices in billing requirements as related to Authorization
Leads or serves on recurring workgroups and special projects