Authorization Specialist - Remote - Home Health at Fairmont Homecare

Irving, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

06 Jul, 26

Salary

0.0

Posted On

07 Apr, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Prior authorization, Insurance verification, Home health, Medicare advantage, Medicaid, Clinical documentation, EMR systems, Kinnser, Wellsky, Microsoft Office, Time management, Communication, Problem-solving, Customer service, Appeals support, Regulatory compliance

Industry

Home Health Care Services

Description

Description Join Life Care Home Health Family! ServingServing Texas, Florida, Nevada, Georgia, and Arizona, we provide skilled nursing, therapy, homecare, hospice, palliative care, and private duty services. Why Work With Us? Nestmed AI Scribe: Less charting, more caring! Competitive pay, 401k, health & life insurance Flexible schedules & career growth opportunities Continuing education & recognition programs Supportive, family-like team culture Make a difference in patients’ lives while enjoying work-life balance. Apply today and grow with us! 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

Responsibilities

The Authorization Specialist is responsible for obtaining, tracking, and maintaining prior authorizations for home health services while ensuring compliance with payer requirements. This role acts as a liaison between clinical staff, physicians, and insurance providers to facilitate timely service approvals and accurate reimbursement.