Home Healthcare Pre-Authorization

MUST HAVE HOME HEALTHCARE EXPERIENCE

ONSITE NO REMOTE OR HYBRID

Human Touch is seeking an experienced Home Health Prior Authorization Specialist to manage the authorization process for patients receiving home health services.

The Prior Authorization Specialist will be responsible for obtaining initial and continued authorizations from insurance companies and managed care organizations, verifying patient eligibility and benefits, submitting required clinical documentation, tracking authorization status and expiration dates, and communicating with payers, clinicians, referral sources, and internal staff.

The ideal candidate will have experience working with home health insurance authorizations , Medicaid, Medicare Advantage, managed care organizations, and payer portals. Strong attention to detail, organization, follow-up, and knowledge of home health documentation requirements are essential.

Benefits:

- Competitive salary commensurate with experience.

- Opportunities for professional development and career advancement.

- Positive and supportive work environment

- Contribution to improving healthcare access and quality in the community

- Comprehensive benefits package including:

Health insurance

- Vision

- Dental

- Paid Time Off

- Sick Leave

- Retirement plans

Essential Duties and Responsibilities

- Obtain prior authorizations for home health services, including skilled nursing, physical therapy, occupational therapy, speech therapy, and other covered services as applicable.

- Review referrals and patient information to determine authorization requirements.

- Verify patient insurance eligibility, benefits, coverage, and authorization requirements.

- Submit initial authorization requests to insurance companies and managed care organizations.

- Submit requests for continued services and additional visits when medically necessary.

- Review authorization requirements and ensure all required clinical documentation is submitted accurately and timely.

- Coordinate with clinical staff to obtain OASIS assessments, plans of care, therapy evaluations, physician orders, progress notes, and other required documentation.

- Track authorization requests from submission through approval, denial, or pending status.

- Monitor authorization expiration dates and proactively initiate renewal requests to prevent gaps in patient services.

- Maintain accurate authorization records in the agency's electronic medical record and/or authorization tracking system.

- Document authorization numbers, approved disciplines, approved visits/units, effective dates, expiration dates, and payer requirements.

- Communicate authorization decisions and updates to clinical and administrative teams.

- Follow up with insurance companies and managed care organizations regarding pending authorization requests.

- Identify missing or incomplete documentation that may delay authorization and work with the appropriate department to obtain it.

- Assist with resolving authorization denials, requests for additional information, and other payer-related issues.

- Escalate urgent authorization issues that may affect patient care or service continuity.

- Maintain knowledge of payer-specific authorization requirements and procedures.

- Utilize payer portals, telephone systems, fax systems, and electronic communication to submit and track authorization requests.

- Maintain confidentiality of patient information and comply with HIPAA requirements.

- Maintain accurate records and reports related to authorization activity.

- Work collaboratively with intake, clinical, billing, scheduling, and management teams.

- Perform other duties as assigned.

Required Qualifications

- High school diploma or GED required.

- 2+ years of experience in medical insurance authorization, utilization management, referral coordination, or a related healthcare administrative role.

- Home health authorization experience strongly preferred.

- Experience working with Medicare Advantage, Medicaid, commercial insurance, and/or managed care organizations preferred.

- Knowledge of home health services and authorization requirements.

- Experience using insurance payer portals and electronic medical record systems.

- Strong computer and data-entry skills.

- Excellent verbal and written communication skills.

- Strong organizational skills and attention to detail.

- Ability to manage multiple authorization requests and deadlines simultaneously.

- Ability to work independently while maintaining effective communication with the clinical and administrative teams.

Preferred Experience

Candidates with experience in any of the following areas are strongly preferred:

- Home health authorization

- Home health intake

- Utilization management

- Insurance verification

- Medicaid authorization

- Medicare Advantage authorization

- Managed care organizations

- OASIS documentation

- Plan of Care / 485 documentation

- Therapy authorization

- Payer portals

- Referral coordination

- Clinical documentation review

Knowledge, Skills & Abilities

The successful candidate should have:

- Strong understanding of insurance authorization processes.

- Ability to interpret payer requirements and identify required documentation.

- Excellent follow-up and time-management skills.

- Strong attention to detail and accuracy.

- Ability to prioritize urgent authorization requests.

- Ability to communicate effectively with insurance representatives and healthcare professionals.

- Ability to maintain patient confidentiality and protect PHI.

- Ability to work effectively in a fast-paced home health environment.

- Strong problem-solving and critical-thinking skills.

- Professional and courteous communication style.

- Ability to meet established deadlines and productivity expectations.

Key Performance Responsibilities

The Prior Authorization Specialist is expected to:

- Process authorization requests accurately and within required timeframes.

- Maintain accurate authorization tracking records.

- Minimize delays in patient start of care and continued services.

- Monitor authorization expiration dates and initiate renewals timely.

- Maintain consistent communication with clinical and administrative staff.

- Ensure required documentation is submitted to payers.

- Follow payer-specific requirements and agency policies.

HIPAA & Confidentiality

This position will have access to Protected Health Information (PHI) as part of its responsibilities. The employee must maintain strict confidentiality and comply with HIPAA regulations, agency privacy and security policies, and all applicable federal and District of Columbia requirements.

Work Environment

This is an administrative position based in Washington, DC . The position requires regular communication with insurance companies, healthcare providers, clinicians, patients, referral sources, and internal departments.

Position Details

Job Type: Full-time
Pay: $23.00-$26.00 per hour, based on experience
Schedule: Monday-Friday, 8-hour shift
Weekends: No weekends
Work Location: Washington, DC - In Person ONSITE NO REMOTE OR HYBRID

This job description is intended to describe the general nature and level of work performed in this position. It is not intended to be an exhaustive list of all duties, responsibilities, qualifications, or requirements. Additional responsibilities may be assigned based on the needs of the organization.