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, monitor insurance lifetime caps and prior authorization periods. Schedule : Remote Mon-Fri 40 hours per week. >> We offer our team the best << Medical, Dental and Vision Benefits Continued Education PTO Plan Retirement Planning Life Insurance Employee discounts 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. Documentation and Data Entry 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. Payor Transfer and Coordinatio n 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. Expired Reports and Requesting Authorization 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. Branch Support and Communications 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. Quality Assurance and Compliance 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. Key Strengths/Requirements in the Role 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

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

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.