Onsite Home Health Prior Authorization Specialist

Human Touch Home Health Care; Washington (District of Columbia); On-site; USD 32,000 - 36,000; Full time

Benefits offered by this job

Health insurance

Vision

Dental

Paid Time Off

Sick Leave

Retirement plans

Professional development opportunities

Positive work environment

Job summary

Human Touch Home Health Care is seeking an experienced Home Health Prior Authorization Specialist to manage authorizations for home health services in Washington, DC. The role requires on-site work with no remote or hybrid options.

You will obtain initial and continued authorizations, verify eligibility, submit documentation, and coordinate with clinical staff to support timely patient care. Strong knowledge of payer requirements and EMR usage is essential.

Qualifications

• 2+ years of experience in medical insurance authorization, utilization management, referral coordination, or a related healthcare administrative role.
• Home health authorization experience strongly preferred.
• Experience with Medicare Advantage, Medicaid, commercial insurance, or managed care organizations preferred.
• Knowledge of home health services and authorization requirements.
• Experience using payer portals and EMR systems.

Responsibilities

• Obtain prior authorizations for home health services (skilled nursing, therapy, and other covered services).
• Review referrals to determine authorization requirements.
• Verify insurance eligibility, benefits, and authorization requirements.
• Submit initial authorization requests to payers.
• Submit requests for continued services and renewals when medically necessary.
• Coordinate with clinical staff to obtain necessary documentation (OASIS, plans of care, etc.).
• Track authorization status from submission to approval/denial/pending.
• Monitor expiration dates and renewals to prevent gaps in service.
• Maintain accurate records in EMR/authorization system.
• Communicate outcomes to clinical and administrative teams.

Skills

Verbal and written communication

Organizational skills

Attention to detail

Multitasking

Confidentiality

Education

High school diploma or GED

Tools

Insurance payer portals

EMR systems

Job description

Human Touch Home Health Care is seeking an experienced Home Health Prior Authorization Specialist to manage authorizations for home health services in Washington, DC. The role requires on-site work with no remote or hybrid options.

You will obtain initial and continued authorizations, verify eligibility, submit documentation, and coordinate with clinical staff to support timely patient care. Strong knowledge of payer requirements and EMR usage is essential.