Enterprise Authorization Specialist

Home Care Providers of Texas•Springfield, MO

About The Position

The Home Health Authorization Specialist is responsible solely for obtaining, managing, and maintaining prior authorizations for home health services. The specialist ensures timely authorization approvals to prevent delays in patient care and reimbursement.

Requirements

High school diploma or equivalent required
Proficiency with EMR systems and payer portals
Strong attention to detail and organizational skills
Excellent time management and follow-up skills
Strong written and verbal communication
Ability to prioritize multiple authorization requests under tight deadlines
Analytical problem-solving skills related to payer requirements and denials
Ability to work independently with minimal supervision

Nice To Haves

Prior experience with high-volume authorization environments
Remote authorization experience
Strong knowledge of prior authorization processes for Medicare Advantage, Medicare, and commercial plans

Responsibilities

Obtain prior authorizations for home health services from Medicare, Medicare Advantage plans, and commercial payers
Submit authorization requests through payer portals, fax, phone, or electronic systems as required
Ensure accuracy and completeness of clinical documentation required for authorization submission
Track authorization status and follow up with payers to ensure timely determinations
Communicate authorization approvals, denials, and pending statuses to intake, clinical, and billing teams
Maintain detailed documentation of authorization numbers, approved services, visit counts, and effective dates
Monitor authorization expirations and request extensions or reauthorizations as needed
Escalate authorization delays or denials according to established workflows
Maintain compliance with payer guidelines, state regulations, and company policies
Meet productivity and turnaround time standards for authorization submissions and follow-ups