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

Hartford HealthCare at Home•Farmington, CT

12d•Onsite

About The Position

Work where every moment matters. Every day, over 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network as an Authorization Specialist. Hartford HealthCare at Home, the largest provider of homecare services in Connecticut, has been fulfilling our mission for more than 115 years. Our Person-Centered Care Model allows our colleagues to learn and grow within our organization, all while providing integrated support to the patient. As part of Hartford HealthCare, we leverage cutting edge technology to provide quality care in our client’s home. Most importantly, our colleagues are appreciated for the real differences they make in both the lives of their clients and their clients’ families. Under the direction of the Prebilling and Authorization Manager, the Authorization Specialist is responsible for all insurance verification and prior authorization activities for Home Health and Hospice services. This role ensures timely and accurate verification of insurance eligibility, obtains required authorizations, maintains authorization documentation, and enters information into the electronic medical record (EMR) system, Homecare Homebase (HCHB). The Authorization Specialist serves as a liaison between insurance companies, clinical teams, and leadership to support efficient patient care delivery and timely billing.

Requirements

High School Diploma or GED required.
Minimum of one year of experience working with insurance verification and prior authorizations required.
Knowledge of insurance verification, eligibility determination, and prior authorization processes.
Familiarity with Medicare, Medicare Advantage, Medicaid, commercial insurance plans, and other government payers.
Experience using payer portals, clearinghouses, and electronic medical record systems.
High attention to detail, accuracy, and confidentiality.
Strong problem-solving skills and commitment to customer service excellence.

Nice To Haves

Two to four years of experience in a healthcare environment preferred.
Home Health and/or Hospice experience is strongly preferred.
Proficiency with Homecare Homebase (HCHB) or similar healthcare software preferred.
Strong understanding of Home Health and Hospice services, regulations, and reimbursement guidelines.

Responsibilities

Verify insurance eligibility, benefits, and authorization requirements for Home Health and Hospice patients in a timely and accurate manner.
Obtain prior authorizations through insurance portals, phone, fax, and other payer-specific processes.
Submit required clinical documentation to insurance carriers and follow up on authorization requests as needed.
Document eligibility and authorization information accurately within Homecare Homebase (HCHB).
Monitor daily authorization workflows and communicate authorization status updates, coverage issues, and payer changes to leadership and operational teams.
Ensure authorization information is entered promptly to support accurate billing and reimbursement.
Communicate changes in insurance eligibility, authorizations, payer requirements, and regulatory guidelines to management and relevant departments.
Maintain up-to-date knowledge of payer policies, authorization requirements, and reimbursement guidelines.
Serve as a resource for insurance-related questions and provide professional support to clinicians, managers, patients, and payers.
Manage accounts in accordance with payer guidelines and ensure authorization requests are submitted within required timeframes.
Escalate authorization delays, denials, and coverage concerns management as appropriate.
Support denial management and audit activities by reviewing authorization documentation and assisting with investigations.
Collaborate with hospital and departmental staff regarding billing, insurance verification, and authorization processes.
Assist with onboarding and training of new authorization staff.
Perform additional duties and special projects as assigned.