Medical Insurance Authorization Specialist

Job Summary:

The Insurance Authorization Representative is responsible for obtaining and managing prior authorizations from insurance providers for home health care services. This role ensures all services are approved, compliant with payer requirements, and processed efficiently to avoid delays in patient care and reimbursement. The position also requires strong knowledge of home health intake protocols, HIPAA regulations, ICD-10 coding, and proficiency in Axxess Technology Solutions EMR software.

Key Responsibilities:

• Verify patient insurance coverage and eligibility for home health services
• Obtain prior authorizations for services such as skilled nursing, therapy, and home health aide visits
• Communicate with insurance companies to submit clinical documentation and authorization requests
• Track and follow up on pending authorizations to ensure timely approvals
• Maintain accurate records of authorization status in Axxess EMR
• Utilize Axxess Technology Solutions EMR for documentation, tracking, and communication
• Collaborate with intake coordinators and clinical staff to ensure proper processing of new referrals
• Follow and support home health intake protocols, including referral intake, documentation review, and service coordination
• Ensure all patient information is handled in compliance with HIPAA privacy and security regulations
• Review and apply appropriate ICD-10 diagnosis codes to support authorization requests
• Ensure documentation aligns with ICD-10 coding and payer medical necessity requirements
• Review payer guidelines and ensure compliance with insurance requirements
• Resolve authorization denials by submitting appeals or additional documentation
• Coordinate with billing department to ensure services are authorized before claims submission
• Stay updated on insurance policies, Medicare/Medicaid regulations, ICD-10 updates, and payer changes

Qualifications:

• High school diploma or equivalent (Associate’s or Bachelor’s preferred)
• 1–3 years of experience in healthcare insurance verification or authorization (home health preferred)
• Knowledge of Medicare, Medicaid, and commercial insurance policies
• Strong understanding of home health intake processes and workflows
• Proficiency with Axxess Technology Solutions EMR software (required or strongly preferred)
• Knowledge and understanding of HIPAA regulations and patient confidentiality requirements
• Familiarity with ICD-10 coding and its application in authorization and billing processes
• Familiarity with medical terminology and home health services
• Strong communication and organizational skills
• Ability to multitask and meet deadlines in a fast-paced environment

Preferred Skills:

• Experience in home health or hospice setting
• Knowledge of OASIS documentation (a plus)
• Billing or revenue cycle experience
• Strong problem-solving and follow-up skills

Work Environment:

• Office or remote setting depending on agency policy
• Frequent communication with insurance providers, clinicians, intake staff, and administrative teams

Performance Metrics:

• Authorization turnaround time
• Approval/denial rates
• Accuracy of documentation in Axxess EMR
• Compliance with HIPAA and regulatory standards
• Accuracy and appropriate use of ICD-10 coding
• Timeliness of intake and authorization processing

Pay: $20.00 - $25.00 per hour

Benefits:

• 401(k)
• Paid time off

Experience:

• Insurance Auth./Home Health Care : 2 years (Required)
• Home Health Care: 2 years (Required)

Work Location: In person