Authorization Specialist - Home Care Agency (On-Site)

YELM US Associates, LLC; New York (NY); On-site; USD 34,000 - 39,000; Full time

Benefits offered by this job

Paid Time-Off

Medical Coverage

Vision

Dental Benefits

401k Retirement plan + Employer Match

Voluntary Life

Critical Illness

Group Hospital Indemnity

Accident Insurance

Job summary

YELM US Associates, LLC is the administrative division supporting our licensed home care agencies, Ultimate Care and Swift Home Care. This on-site authorization role offers $25-$28 per hour, with schedule Monday–Friday 9:00AM–5:00PM at 1000 Gates Avenue, Brooklyn, NY 11221, reporting to the Director of Authorizations.

You will process and track authorizations, review patient records, and communicate with insurers to secure and revise authorizations.

Qualifications

• Minimum of 1 year experience in an Authorizations related role in a Home Care agency.
• Proficiency with HHA eXchange.
• Proficiency with Excel.

Responsibilities

• Process and track authorizations for home health services, ensuring timely submission to insurance providers.
• Review patient records and treatment plans to ensure all required documentation is complete and accurate.
• Communicate with insurance companies to secure necessary authorizations for services.
• Communicate with insurance companies regarding revised authorizations and other requested documents.
• Manage and resolve issues related to denied or delayed authorizations, including re-submissions or appeals.
• Maintain detailed and accurate records of all authorization activities.
• Collaborate with clinicians, case managers, and other team members to ensure care plans align with authorization requirements.
• Stay updated on changes in insurance policies, billing codes, and regulatory requirements related to home care.
• Provide exceptional customer service to both internal and external stakeholders, ensuring clear and efficient communication.
• Weekly review of admissions, discharges, and temp auth reports
• Monitor payer Portals and follow up branch / Intake’s requests
• Notify the teams of changes in authorization e.g. Termination, Holds, Hospitalizations, Increases and Decreases.
• Verify Eligibility the first business day of the month and the 15th for flagged known potential issues, Reach out to all insurances Via email/phone regarding potential termination or continuations of services.
• Monitor the HHAEX Board (Accept or Deny cases)
• Monitor/review Payor messages on the Home screen, update HHAEX and advise Placement of any changes accordingly.
• Run Reports from HHAEX (Temp Report, Authorizations due by Date Report, Authorizations Report)
• Create Profiles for New members in HHAEX.
• Merge profiles so all Clinical Documents are kept in one place.
• Monitor Mail (some contracts still send authorizations via mail)

Skills

Organizational skills

Problem-solving

Communication

Collaboration

Education

High school diploma or equivalent

Tools

HHA eXchange

Excel

Job description

YELMUS Associates is the administrative division supporting our licensed home care agencies, Ultimate Care and Swift Home Care.

Compensation: $25 - 28 per hour, based on relevant experience.

Location: 1000 Gates Avenue, 4th Floor, Brooklyn, NY 11221

Schedule: Monday-Friday 9:00AM-5:00PM, Onsite

Report to: Director of Authorizations

Responsibilities:

• Process and track authorizations for home health services, ensuring timely submission to insurance providers.
• Review patient records and treatment plans to ensure all required documentation is complete and accurate.
• Communicate with insurance companies to secure necessary authorizations for services.
• Communicate with insurance companies regarding revised authorizations (fax time/sheets) and other requested documents.
• Manage and resolve issues related to denied or delayed authorizations, including re-submissions or appeals.
• Maintain detailed and accurate records of all authorization activities.
• Collaborate with clinicians, case managers, and other team members to ensure care plans align with authorization requirements.
• Stay updated on changes in insurance policies, billing codes, and regulatory requirements related to home care.
• Provide exceptional customer service to both internal and external stakeholders, ensuring clear and efficient communication.
• Weekly review of admissions, discharges, and temp auth reports
• Monitor payer Portals and follow up branch / Intake’s requests
• Notify the teams of changes in authorization e.g. Termination, Holds, Hospitalizations, Increases and Decreases.
• Verify Eligibility the first business day of the month and the 15th for flagged known potential issues, Reach out to all insurances Via email/phone regarding potential termination or continuations of services.
• Monitor the HHAEX Board (Accept or Deny cases)
• Monitor/review Payor messages on the Home screen, update HHAEX and advise Placement of any changes accordingly.
• Run Reports from HHAEX (Temp Report, Authorizations due by Date Report, Authorizations Report)
• Create Profiles for New members in HHAEX.
• Merge profiles so all Clinical Documents are kept in one place.
• Monitor Mail (some contracts still send authorizations via mail)

Qualifications:

• Must have a minimum of 1 year experience working in an Authorizations related role in a Home Care agency.
• Proficiency with HHA eXchange.
• Proficiency with Excel.
• Strong organizational, critical thinking, and problem-solving skills with attention to detail.
• Must be able to take initiative, initiate appropriate follow-up with others and related to completing task thoroughly and accurately.
• Effective communication and interpersonal skills, enabling you to build rapport with clients, caregivers, and healthcare professionals.
• Ability to work in collaborative environment across departments

Education:

• High school diploma or equivalent required.

We offer the Ultimate employee perks (literally)!

• Paid Time-Off
• Medical Coverage, Vision, and Dental Benefits
• 401k Retirement plan + Employer Match
• Voluntary Life, Critical Illness, Group Hospital Indemnity, Accident Insurance

About Us

Our mission is to provide and restore client dignity and independence in their homes through individualized care plans that reduce caregiver role strain and stress on family members while helping clients avoid nursing homes and assisted living facilities. YELM US Associates LLC is a licensed home care provider offering comprehensive home care services. We lead with our hearts to deliver top-quality, compassionate, and empathetic care.

Why Choose Us?

At Ultimate Care, we are dedicated to fostering a people-centric culture that is pivotal for success in the contemporary home care landscape. Our unwavering commitment begins with inspiring and empowering our employees to unleash their full potential. We actively pursue avenues to cultivate a dynamic learning environment, allowing our team members to explore and nurture their passions and talents. Our goal is to facilitate holistic growth, both personally and professionally, whether within the office or beyond. Join us on this journey of empowerment and achievement!

At Ultimate Care and our affiliates, we're committed to creating a diverse, inclusive, and authentic workplace. If you're enthusiastic about the role but don't meet every qualification in the job description, we encourage you to apply. You could be the ideal candidate for this or other roles!

Ultimate Care is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion, sex, national origin, disability, protected veteran status, or any other characteristic protected under federal, state, or local law.

Ultimate Care does not accept resumes from unsolicited search firms nor recruiters.