Job Description
Job Title: Insurance Authorization Specialist
Department: Eligibility & Authorization
Reports To: SVP of Patient Care Coordination
Position Type: Full-Time
GENERAL SUMMARY
The Insurance Authorization Specialist is responsible for obtaining and verifying insurance authorizations for all home health and hospice services provided by the agency. This role ensures timely and accurate processing of authorizations, facilitates the appeals process when necessary, and works closely with clinical and administrative teams to support optimal patient care and service delivery.
ESSENTIAL DUTIES
1. Verify patient insurance coverage and eligibility for home health and hospice services.
2. Obtain prior authorizations and re-authorizations from private insurers, Medicare Advantage plans, and Medicaid as required.
3. Maintain accurate and up-to-date records of insurance authorizations in Home Care Home Base (HCHB).
4. Communicate with physicians’ offices, insurance companies, and internal departments to coordinate and secure timely authorizations.
5. Initiate and track appeals for denied or delayed authorizations.
6. Educate internal staff on payer-specific authorization requirements and updates.
7. Work collaboratively with intake, billing, and clinical teams to prevent delays in patient care.
8. Follow up on pending authorizations to ensure continuity of services.
9. Comply with HIPAA regulations and agency policies regarding patient information and documentation.
10. Participate in weekend and holiday coverage rotations as assigned.
11. Other duties as assigned.
- SPECIAL SKILLS AND ABILITIES REQUIRED
- Strong understanding of the insurance authorization and appeals process.
- Proficient in using electronic medical records (EMR) and insurance portals.
- Excellent verbal and written communication skills.
- Strong attention to detail, organizational skills, and the ability to prioritize workload.
- Ability to work independently and as part of a team in a fast-paced environment.
- EDUCATION
- High school diploma or equivalent required
- EXPERIENCE
- Minimum 1 year of experience in insurance verification and authorization, preferably in a home health or hospice setting.
- CORE COMPETENCIES
- Build credibility and trust
- Collaborate with others
- Demonstrate interpersonal understanding and utilize effective communication skills
- Deliver results
- Analyze problems and make sound decisions
- Demonstrate resilience under pressure
- Commit to continuous learning and improvement
- DEGREE OF TRAVEL
- None.
Job Title: Insurance Authorization Specialist
Department: Eligibility & Authorization
Reports To: SVP of Patient Care Coordination
Position Type: Full-Time
GENERAL SUMMARY
The Insurance Authorization Specialist is responsible for obtaining and verifying insurance authorizations for all home health and hospice services provided by the agency. This role ensures timely and accurate processing of authorizations, facilitates the appeals process when necessary, and works closely with clinical and administrative teams to support optimal patient care and service delivery.
ESSENTIAL DUTIES
1. Verify patient insurance coverage and eligibility for home health and hospice services.
2. Obtain prior authorizations and re-authorizations from private insurers, Medicare Advantage plans, and Medicaid as required.
3. Maintain accurate and up-to-date records of insurance authorizations in Home Care Home Base (HCHB).
4. Communicate with physicians’ offices, insurance companies, and internal departments to coordinate and secure timely authorizations.
5. Initiate and track appeals for denied or delayed authorizations.
6. Educate internal staff on payer-specific authorization requirements and updates.
7. Work collaboratively with intake, billing, and clinical teams to prevent delays in patient care.
8. Follow up on pending authorizations to ensure continuity of services.
9. Comply with HIPAA regulations and agency policies regarding patient information and documentation.
10. Participate in weekend and holiday coverage rotations as assigned.
11. Other duties as assigned.
- SPECIAL SKILLS AND ABILITIES REQUIRED
- Strong understanding of the insurance authorization and appeals process.
- Proficient in using electronic medical records (EMR) and insurance portals.
- Excellent verbal and written communication skills.
- Strong attention to detail, organizational skills, and the ability to prioritize workload.
- Ability to work independently and as part of a team in a fast-paced environment.
- EDUCATION
- High school diploma or equivalent required
- EXPERIENCE
- Minimum 1 year of experience in insurance verification and authorization, preferably in a home health or hospice setting.
- CORE COMPETENCIES
- Build credibility and trust
- Collaborate with others
- Demonstrate interpersonal understanding and utilize effective communication skills
- Deliver results
- Analyze problems and make sound decisions
- Demonstrate resilience under pressure
- Commit to continuous learning and improvement
- DEGREE OF TRAVEL
- None
About Us
Why work for LifeSpring Home Care and Affiliates?
We provide our employees with an atmosphere that will encourage them to develop their talents to their highest potential while being caregivers to those in need of home health, hospice, or personal services. Join our Team to provide inspired care by offering a loving professional team approach to rendering care, allowing a patient to comfortably remain where they live for as long as services are required.
Wondering what amazing benefits we can offer you?
- Full-Time Benefits
- Medical - We offer three options including PHCS PPO Plan, PHCS HSA Plan, or Preventive Plus.
- Dental and Vision - Take advantage of our Delta Dental and VSP plans!
- 401k Match - We offer a very generous 401k match!
- Paid Time Off - You will begin earning paid time off from day one! The annual average for paid time off accrual is 18 days per year to start.
- AFLAC - You can access short term disability, accident, and cancer policies through AFLAC.
- Part-Time & PRN Benefits
- Medical - Part-time and prn staff are offered Preventive Plus Plan coverage.
- 401k Match - If you average over 1000 hours per year, we offer a very generous 401k match!
- AFLAC -You can access short term disability, accident, cancer policies through AFLAC.
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