Home Health Authorizations Coordinator (Part-time)

AdminEdge; Metro Manila; Remote; PHP 614.000 - 702.000; Teilzeit

Benefits dieser Stelle

Fully remote

Fixed US schedule

PTO: 10 days + 6 holidays

Zusammenfassung

AdminEdge is seeking a Home Health Authorizations Coordinator (Remote - US Client) in the Philippines. This part-time role (20 hours/week) supports insurance authorization workflows, including submissions, validation of payer requirements, and tracking approvals.

PST-hours alignment is required. The ideal candidate has at least 3 years in US healthcare authorizations, strong communication, and the ability to navigate multiple payer portals.

Qualifikationen

• Minimum 3 years of experience supporting US-based healthcare organizations, preferably in home health authorizations or revenue cycle.
• Experience processing prior authorizations for US home health services.
• Knowledge of managed care plans (commercial, Medicaid, Medicare Advantage, HMOs, IPAs).
• Understanding of home health skilled nursing, therapy, and clinical documentation requirements.
• Ability to navigate payer portals, identify required documentation, and escalate issues.

Aufgaben

• Prepare, submit, and track initial and ongoing authorization requests for home health services.
• Review referrals, physician orders, diagnoses, and clinical records to identify information for authorization.
• Verify medical necessity and supporting documentation for requested skilled services.
• Identify patient diagnoses and clinical justification for requested services.
• Submit authorizations through payer portals and medical group platforms.
• Monitor pending authorizations and follow up with payers and groups.
• Track approval dates, authorized visits, and expiration dates.
• Assist with extensions and reauthorization submissions.
• Escalate missing information or coverage issues as needed.

Kenntnisse

English fluency

US healthcare knowledge

Prior auth experience

Healthcare documentation

Attention to detail

Remote collaboration

Jobbeschreibung

Position: Home Health Authorizations Coordinator (Remote - US Client)

Job Type:Part-time (20 hours per week with potential to increase)

Location:Philippines (Remote, PST hours)

Salary: $7-8/hr

Overview

We are seeking an experienced Home Health Authorizations Coordinator to support the agency's insurance authorization processes, including submitting authorization requests, verifying payer requirements, coordinating with insurance companies and medical groups, and tracking authorization approvals.

This position requires a solid understanding of US home health services, medical terminology, skilled care requirements, and the fundamentals of insurance authorization. The coordinator must be comfortable navigating multiple payer portals and understanding how authorization requirements differ among commercial insurance, Medicaid, Medicare Advantage, HMOs, and Independent Practice Associations (IPAs).

The agency works with numerous insurance plans and authorization platforms, each with its own submission requirements and procedures. Training will be provided on agency-specific payer workflows, with an emphasis on applying established authorization principles across different insurance systems.

Key Responsibilities

Insurance Authorizations & Prior Approval

• Prepare, submit, and track initial and ongoing authorization requests for home health services.
• Review referral documentation, physician orders, diagnoses, and clinical records to identify the information required for authorization.
• Verify medical necessity and supporting documentation for requested skilled nursing, therapy, and other home health services.
• Identify the patient's primary diagnosis, skilled care needs, and clinical justification for requested services.
• Submit authorization requests through insurance company portals, medical group platforms, and other designated submission channels.
• Monitor pending authorizations and follow up with insurance companies, medical groups, and appropriate agency personnel.
• Track authorization approval dates, authorized visits, service limitations, and expiration dates.
• Assist with authorization extensions, additional visit requests, and reauthorization submissions.
• Identify missing information, authorization delays, and potential coverage issues requiring escalation.

Managed Care & Insurance Coordination

• Work with commercial insurance, Medicaid managed care, Medicare Advantage, HMO, and other managed care plans.
• Determine the appropriate authorization pathway based on the patient's specific insurance plan and benefit structure.
• Identify whether authorization requests must be submitted directly to the insurance carrier or through a delegated IPA or medical group.
• Navigate different payer-specific portals and authorization platforms according to established procedures.
• Verify payer requirements, including required documentation, submission methods, and applicable authorization criteria.
• Coordinate with insurance representatives and medical groups to clarify authorization requirements or resolve pending requests.
• Maintain accurate records of payer-specific authorization processes and submission instructions.
• Recognize differences among insurance products offered by the same carrier and adjust authorization workflows accordingly.

Clinical Documentation & Procedure Code Review

• Review clinical documentation to identify diagnoses, skilled needs, and the justification for requested home health services.
• Verify that authorization requests accurately describe the services being requested and the clinical reasons those services are necessary.
• Identify and apply appropriate home health service and procedure codes according to payer-specific requirements.
• Recognize differences in coding requirements among insurance carriers, including applicable HCPCS G-codes, S-codes, and other payer-designated procedure codes.
• Confirm requested visit types, service units, and frequencies align with the clinical documentation and applicable payer requirements.
• Identify incomplete or inconsistent documentation that may delay authorization approval.
• Coordinate with clinical staff to obtain missing orders, supporting documentation, or clarification of skilled care needs.
• Escalate unclear coding, medical necessity, or coverage issues to the appropriate agency personnel before submission.

Authorization Tracking & Operational Support

• Maintain organized authorization records within the agency's electronic medical record system and designated tracking tools.
• Monitor authorization status to help prevent delays in patient admissions, ongoing visits, and continuity of care.
• Communicate authorization approvals, pending requests, denials, and service limitations to appropriate agency staff.
• Track authorization expiration dates and proactively identify cases requiring renewal or additional visits.
• Assist with resolving authorization discrepancies, missing approvals, and payer communication issues.
• Maintain accurate documentation of authorization submissions, payer responses, and follow-up activities.
• Support efficient processing of a high volume of managed care referrals and authorization requests.
• Follow established agency procedures for protecting patient information and maintaining HIPAA compliance.

Preferred Skills & Qualifications

• Minimum 3 years of experience supporting US-based healthcare organizations, preferably in home health authorizations, insurance coordination, or related revenue cycle operations.
• Previous experience processing prior authorizations for US home health services.
• Working knowledge of managed care insurance, including commercial plans, Medicaid managed care, Medicare Advantage, HMOs, and IPAs.
• Understanding of home health skilled nursing, therapy services, medical terminology, and clinical documentation requirements.
• Ability to identify diagnoses, skilled care needs, and supporting clinical justification for authorization requests.
• Familiarity with HCPCS procedure codes commonly used for home health services and the ability to follow payer-specific coding requirements.
• Experience navigating insurance portals, submitting authorization requests, and following up on pending approvals.
• Ability to distinguish among different insurance products and determine the appropriate authorization submission pathway.
• Strong organizational skills and ability to manage multiple pending authorizations, deadlines, and follow-up activities.
• Excellent written and verbal English communication skills.
• Strong attention to detail, problem-solving skills, and ability to learn new insurance platforms and workflows.
• Experience working with electronic medical records and authorization tracking systems.
• Ability to work independently in a high-volume, fast-paced environment.
• Availability to work remotely during US-Pacific business hours.
• Commitment to patient confidentiality, HIPAA compliance, and accurate healthcare documentation.

Nice-to-Have (Bonus Skills)

• Experience supporting home health agencies with predominantly managed care patient populations.
• Familiarity with Nevada Medicaid managed care plans and regional insurance authorization processes.
• Experience coordinating authorizations through delegated IPAs, medical groups, and HMO networks.
• Knowledge of payer-specific home health HCPCS G-codes, S-codes, and service unit requirements.
• Experience with DataSoft, Axxess, or comparable home health EMR platforms.
• Familiarity with Blue Cross Blue Shield authorization workflows across different insurance products.
• Experience with authorization extensions, additional visit requests, and denial follow-up.
• Experience supporting home health intake, referral coordination, or insurance eligibility verification.
• Familiarity with AI-assisted administrative workflows, authorization templates, and documentation tools.
• Clinical background or nursing education, including RN or LPN/LVN qualifications.

What we offer:

• Competitive compensation — $7–$8 per hour, paid in USD
• Fixed U.S. working schedule
• Fully remote role — work from anywhere
• Direct collaboration with U.S. small businesses and entrepreneurs
• Paid time off — 10 PTO days per year, plus 6 U.S. holidays off