Enterprise Authorization Specialist

Job Title: Enterprise Authorization Specialist

Department: Revenue Cycle
Reports To: Authorization Supervisor
Employment Type: [Full-Time / Part-Time / Remote / Onsite]

Position Summary

The Home Health Authorization Specialist is responsible solely for obtaining, managing, and maintaining prior authorizations for home health services. The specialist ensures timely authorization approvals to prevent delays in patient care and reimbursement.

Key Responsibilities

• Obtain prior authorizations for home health services from Medicare, Medicare Advantage plans, and commercial payers
• Submit authorization requests through payer portals, fax, phone, or electronic systems as required
• Ensure accuracy and completeness of clinical documentation required for authorization submission
• Track authorization status and follow up with payers to ensure timely determinations
• Communicate authorization approvals, denials, and pending statuses to intake, clinical, and billing teams
• Maintain detailed documentation of authorization numbers, approved services, visit counts, and effective dates
• Monitor authorization expirations and request extensions or reauthorizations as needed
• Escalate authorization delays or denials according to established workflows
• Maintain compliance with payer guidelines, state regulations, and company policies
• Meet productivity and turnaround time standards for authorization submissions and follow-ups

·        Preferred Qualifications

• High school diploma or equivalent required
• Proficiency with EMR systems and payer portals
• Strong attention to detail and organizational skills

• Prior experience with high-volume authorization environments
• Remote authorization experience
• Strong knowledge of prior authorization processes for Medicare Advantage, Medicare, and commercial plans

Skills & Competencies

• Excellent time management and follow-up skills
• Strong written and verbal communication
• Ability to prioritize multiple authorization requests under tight deadlines
• Analytical problem-solving skills related to payer requirements and denials
• Ability to work independently with minimal supervision