Authorization Specialist

Position Summary

Home Helpers Home Care is seeking a highly organized, detail-oriented, and process-driven Authorization Specialist to join our Revenue Cycle Management (RCM) team. This role is responsible for managing the authorization process from referral through approval, ensuring timely submissions, accurate documentation, and uninterrupted authorization coverage for client services.

The ideal candidate has experience working with VA, Medicaid, and commercial insurance payers and understands the complexities of healthcare authorizations, reimbursement processes, payer requirements, regulatory compliance, and revenue cycle operations. This position partners closely with Clinical, Scheduling, Billing, Operations, and external payer organizations to ensure clients receive timely care while supporting the organization's financial performance.

This is an excellent opportunity for someone who enjoys building processes, improving workflows, solving operational challenges, and helping shape a growing department. As Home Helpers continues to expand, this position offers a clear path into leadership for the right individual.

• Competitive salary: $55,000-$65,000 annually (DOE)
• Medical, dental, and vision insurance
• Paid Time Off (PTO)
• Paid holidays
• 401(k) (if eligible)
• Professional development and career advancement opportunities
• Collaborative, mission-driven team environment

• Submit, monitor, and obtain initial, concurrent, continued, and reauthorization requests for home care services.
• Review referrals and ensure all required physician orders, clinical documentation, and supporting records are complete prior to authorization submission.
• Track authorization start and end dates and proactively obtain reauthorizations before expiration to prevent interruptions in client care.
• Maintain accurate, complete, and timely documentation within the Electronic Health Record (EHR) and Customer Relationship Management (CRM) systems.
• Demonstrate a working knowledge of HCPCS codes related to home health and home care services.
• Understand and apply payer-specific requirements for VA, Medicaid, commercial insurance, Medicare Advantage, and other contracted payers.
• Communicate authorization status, updates, denials, and potential service interruptions with Clinical, Scheduling, Billing, Operations, and Revenue Cycle Management teams.
• Collaborate closely with Billing to resolve authorization-related claims, reimbursement issues, and payer inquiries.
• Respond promptly to billing escalations involving denied, pending, or rejected claims related to authorization issues. Investigate root causes, coordinate with payers and internal departments, submit required documentation or corrections, and ensure follow-up is completed within established payer and company response time frames to maximize timely reimbursement.
• Assist with authorization appeals, payer reconsiderations, denial management, and claim resolution activities.
• Monitor authorization work queues and prioritize requests to ensure all payer deadlines and turnaround times are met.
• Develop, document, and continuously improve authorization workflows, standard operating procedures (SOPs), and department best practices.
• Identify process improvement opportunities that increase efficiency, reduce authorization turnaround times, improve communication, and support revenue cycle performance.
• Participate in cross-functional operational projects and process improvement initiatives.
• Assist leadership with authorization reporting, productivity tracking, department dashboards, key performance indicators (KPIs), and operational metrics.
• Maintain organized records to support audits, compliance reviews, and quality assurance initiatives.
• Provide exceptional customer service to referral sources, providers, insurance representatives, clients, and internal team members.
• Support training and onboarding of new Authorization Specialists as the department grows.
• Perform other duties and special projects as assigned.

• 3+ years of healthcare authorization experience.
• Experience working with VA, Medicaid, and commercial insurance payers.
• Working knowledge of HCPCS coding for home health and home care services.
• Experience utilizing EHR systems.
• Experience utilizing CRM systems.
• Strong organizational and multitasking skills with the ability to manage competing priorities.
• Excellent analytical, critical thinking, and problem-solving abilities.
• Outstanding written and verbal communication skills.
  
  High attention to detail and commitment to accuracy.
• Proficiency with Microsoft Office Suite, including Outlook and Excel.

• Medical Assistant (MA) experience.
• Experience with biologic medication authorizations.
• Knowledge of healthcare billing claims processing, and denial management.
• Credentialing experience.
• Project management experience.
• Home care, home health, hospice, or healthcare operations experience.
• Customer service and people management experience.
• Experience training,…