Authorization Specialist - Remote - Home Health
Description
Position Summary
The Remote Home Health Authorization Specialist is responsible for obtaining, tracking, and maintaining prior authorizations for home health services in compliance with payer requirements. This role works closely with intake, clinical staff, physicians’ offices, and insurance providers to ensure timely approval of services, minimize delays in care, and support accurate reimbursement.
Key Responsibilities
Authorization & Payer Coordination
Obtain prior authorizations and re-authorizations for home health services (Skilled Nursing, PT, OT, ST, HHA, MSW, etc.).
Verify insurance eligibility, benefits, and authorization requirements for commercial, Medicare Advantage, and Medicaid plans.
Submit complete authorization requests with required clinical documentation within payer timelines.
Track authorization status and follow up with payers until determinations are received.
Communicate authorization approvals, denials, and limitations to intake and clinical teams.
Documentation & Compliance
Ensure all authorizations are accurately documented in the EMR/system.
Maintain compliance with payer contracts, state regulations, and agency policies.
Monitor authorization expiration dates and initiate renewals to prevent service disruption.
Support audits by providing authorization documentation as requested.
Collaboration & Communication
Work closely with clinicians to obtain clinical notes, orders, and supporting documentation.
Communicate with physician offices regarding orders and authorization requirements.
Serve as a liaison between the agency and insurance companies.
Respond promptly to internal and external inquiries regarding authorization status.
Denials & Appeals Support
Identify authorization denials or partial approvals.
Assist with gathering documentation for appeals when applicable.
Escalate complex authorization issues to leadership as needed.
Requirements
Required Qualifications
High school diploma or equivalent
Minimum 2 + years’ experience in home health, healthcare authorization, intake, or insurance verification.
Knowledge of prior authorization processes for home health services
Familiarity with Medicare Advantage, Medicaid MCOs, and commercial payers.
Strong attention to detail and ability to manage multiple authorizations simultaneously.
Proficient in EMR systems ( Kinnser/Wellsky) and Microsoft Office (Outlook, Word, Excel).
Reliable high-speed internet and private, HIPPA-compliant workspace
Skills & Competencies
Strong organizational and time-management skills
Clear written and verbal communication
Problem-solving and follow-up driven mindset
Ability to work independently and as part of a team
Professional phone etiquette and customer service skills
Work Environment
Fully remote, home-based role
Standard business hours aligned with operations
May require coordination across time zones
Apply To This Job
Position Summary
The Remote Home Health Authorization Specialist is responsible for obtaining, tracking, and maintaining prior authorizations for home health services in compliance with payer requirements. This role works closely with intake, clinical staff, physicians’ offices, and insurance providers to ensure timely approval of services, minimize delays in care, and support accurate reimbursement.
Key Responsibilities
Authorization & Payer Coordination
Obtain prior authorizations and re-authorizations for home health services (Skilled Nursing, PT, OT, ST, HHA, MSW, etc.).
Verify insurance eligibility, benefits, and authorization requirements for commercial, Medicare Advantage, and Medicaid plans.
Submit complete authorization requests with required clinical documentation within payer timelines.
Track authorization status and follow up with payers until determinations are received.
Communicate authorization approvals, denials, and limitations to intake and clinical teams.
Documentation & Compliance
Ensure all authorizations are accurately documented in the EMR/system.
Maintain compliance with payer contracts, state regulations, and agency policies.
Monitor authorization expiration dates and initiate renewals to prevent service disruption.
Support audits by providing authorization documentation as requested.
Collaboration & Communication
Work closely with clinicians to obtain clinical notes, orders, and supporting documentation.
Communicate with physician offices regarding orders and authorization requirements.
Serve as a liaison between the agency and insurance companies.
Respond promptly to internal and external inquiries regarding authorization status.
Denials & Appeals Support
Identify authorization denials or partial approvals.
Assist with gathering documentation for appeals when applicable.
Escalate complex authorization issues to leadership as needed.
Requirements
Required Qualifications
High school diploma or equivalent
Minimum 2 + years’ experience in home health, healthcare authorization, intake, or insurance verification.
Knowledge of prior authorization processes for home health services
Familiarity with Medicare Advantage, Medicaid MCOs, and commercial payers.
Strong attention to detail and ability to manage multiple authorizations simultaneously.
Proficient in EMR systems ( Kinnser/Wellsky) and Microsoft Office (Outlook, Word, Excel).
Reliable high-speed internet and private, HIPPA-compliant workspace
Skills & Competencies
Strong organizational and time-management skills
Clear written and verbal communication
Problem-solving and follow-up driven mindset
Ability to work independently and as part of a team
Professional phone etiquette and customer service skills
Work Environment
Fully remote, home-based role
Standard business hours aligned with operations
May require coordination across time zones
Apply To This Job