Reauthorization Specialist

Addus HomeCare•Frisco, TX

2d•Remote

About The Position

The Reauthorization Specialist is responsible for managing all aspects of reauthorizations for client care. This includes re-verifying client eligibility, monitoring insurance lifetime caps and prior authorization periods. The role involves processing new intakes and reauthorizations by reviewing referrals, ensuring all services are authorized within the required timeframe to prevent laps in care, and monitoring authorization start and end dates to proactively manage renewals and prevent expirations. The specialist will also follow up on pending authorizations and communicate updates to the branch. Additionally, they will handle payer transfers, ensuring authorizations are updated and aligned with new payer requirements, and verify coverage details and authorization rules during payer changes to maintain uninterrupted services. The role also includes managing expired authorization reports, identifying discrepancies, and taking corrective action, as well as tracking and resolving authorization issues that may affect billing, scheduling, or services. The Reauthorization Specialist will provide guidance and support to branches regarding authorizations, documents, and the intake process, respond to branch inquiries promptly, and collaborate to resolve issues. Clear and professional communication via email and internal systems is essential to keep all parties informed. The position requires ensuring all processes comply with payer guidelines, company policies, and regulatory standards, identifying errors or discrepancies, and taking corrective action to maintain data integrity. Supporting workflow efficiency by proactively addressing issues before they impact patient care or operations is also a key aspect of the role.

Requirements

Strong attention to detail accuracy in documents and data entry.
Effective communication and collaborations with branch teams.
Ability to manage high volume of authorization and deadlines.
Proactive problems-solving to prevent service disruptions
High school diploma or GED equivalent, some college preferred
1-2 years of recent experience working in a health care setting and insurance authorizations
Excellent written and oral communication skills
Excellent customer service skills
Must be computer literate and possesses knowledge of computer software, Microsoft Excel (advance skills preferred), internet, Word and Outlook
Dependable, conscientious and reliable
Ability to analyze and interpret situations to complete tasks or duties assigned

Nice To Haves

some college preferred
advance skills preferred

Responsibilities

Process Intake, Reauthorization and Payer Transfers.
Process new intakes and reauthorization by reviewing referrals.
Ensure all services are authorized within required time frame to prevent laps in care.
Monitor authorization start and end date to proactively manage renewals and prevent expirations.
Follow up on pending authorization and communicate updates to the branch.
Accurately enter and update authorization detail in the system, ensuring all information align with payer approvals.
Maintain complete, compliant, and well-organized patient records.
Review documentation for accuracy and consistency prior to submission or scanning.
Scan, upload and index authorization documents into the appropriate system and a timely manner.
Handle payer transfers, ensuring authorization are updated and aligned with the new payer requirements.
Verify coverage details and authorization rules during payer change to maintain uninterrupted services.
Manage expired authorization report, identify discrepancies and take corrective action.
Track and resolve authorization issues that may effect billing, scheduling , or services.
Communicate with branches regarding or pending authoriztion and require next step.
Providing guidance and support related to authorization, documents and intake process.
Respond to branch inquiries promptly and collaborate to resolve authorization or documents issues.
Communication clearly and professionally via email and internal systems keep all parties informed.
Ensure all process comply with payor guidelines, company policies and regulatory standards.
Identify errors or discrepancies and take corrective action to maintain data integrity.
Support workflow efficiency by proactively addressing issues before they impact patient care or operations.