Authorization Specialist — Payer & Eligibility Expert

All American Home Care LLC; Philadelphia (Philadelphia County); On-site; USD 45,000 - 60,000; Full time

Job summary

All American Home Care LLC seeks an Authorization Specialist to ensure accurate initial and ongoing payer authorizations and eligibility verification for home care services. You will verify insurance, update the team, and monitor authorizations in HHAeXchange to support efficient billing.

The role requires 2+ years in insurance authorization or related fields, knowledge of Medicare/Medicaid, and strong organizational skills.

Qualifications

• Minimum 2 years in insurance authorization, billing, or business administration (health care/home care preferred).
• Knowledge of Medicare, Medicaid, Waiver Programs, and third-party payer regulations.
• Strong organizational, communication, and decision-making skills.
• Ability to work independently with minimal supervision.
• Proficiency in computer skills; familiarity with HHAeXchange (UPR) and Excel is a plus.
• Successful completion of background studies and screenings.

Responsibilities

• Verify insurance eligibility and authorization promptly and accurately.
• Communicate authorization and eligibility details to Coordinators, CFO, and OM.
• Enter insurance demographic information and monitor ongoing authorizations in HHAeXchange.
• Notify management of non-coverage issues, perform timely re-authorizations, and process discharges.
• Review and ensure authorizations align with billed services.
• Handle payer correspondence, appeals, disputes, and remittances.
• Maintain compliance with HIPAA/state regulations while fostering positive communication with payers, clients, and branch staff.
• Demonstrate initiative in prioritizing tasks and continuously update knowledge to remain a resourceful payer expert.
• Participate in after-hours on-call as needed.

Skills

Insurance authorization

Billing

Independent work

Communication

Tools

HHAeXchange

Excel

Job description

All American Home Care LLC seeks an Authorization Specialist to ensure accurate initial and ongoing payer authorizations and eligibility verification for home care services. You will verify insurance, update the team, and monitor authorizations in HHAeXchange to support efficient billing.

The role requires 2+ years in insurance authorization or related fields, knowledge of Medicare/Medicaid, and strong organizational skills.