Reauthorization Specialist

Addus HomeCare; Frisco (TX); Remote; USD 42,000 - 65,000; Full time

Benefits offered by this job

Medical, Dental and Vision Benefits

Continued Education

PTO Plan

Retirement Planning

Life Insurance

Employee discounts

Job summary

Addus HomeCare is seeking a Reauthorization Specialist to manage client care authorizations, reverify eligibility, and monitor lifetime caps and prior authorization periods. The role involves process intake, payer transfers, and ensuring timely authorizations to prevent care interruptions.

Candidates should have health-care experience, strong data-entry skills, and proficiency in Excel/Outlook. This remote role offers benefits and ongoing education opportunities.

Qualifications

• High school diploma or GED; some college preferred.
• 1–2 years of health care setting and insurance authorizations experience.
• Proficient with MS Office (Excel, Word, Outlook).

Responsibilities

• Process intake and reauthorization by reviewing referrals.
• Ensure authorizations are in place within required time frames to prevent lapses in care.
• Monitor start and end dates to proactively manage renewals and expirations.

Skills

Attention to detail

Communication

Data entry

Problem solving

Time management

Computer literacy

Education

High school diploma or GED

Some college preferred

Tools

Microsoft Excel

Word

Outlook

Job description

Position Summary

The Reauthorization Specialist is responsible for managing all aspects of reauthorizations for client care. This includes re-verifying client eligibility, monitor insurance lifetime caps and prior authorization periods.

Schedule

Remote Mon-Fri 40 hours per week.

• Medical, Dental and Vision Benefits
• Continued Education
• PTO Plan
• Retirement Planning
• Life Insurance
• Employee discounts

Process Intake, Reauthorization and Payer Transfers.

• Process new intakes and reauthorization by reviewing referrals.
• Ensure all services are authorized within required time frame to prevent laps in care.
• Monitor authorization start and end date to proactively manage renewals and prevent expirations.
• Follow up on pending authorization and communicate updates to the branch.

Documentation and Data Entry

• Accurately enter and update authorization detail in the system, ensuring all information align with payer approvals.
• Maintain complete, compliant, and well-organized patient records.
• Review documentation for accuracy and consistency prior to submission or scanning.
• Scan, upload and index authorization documents into the appropriate system and a timely manner.

Payor Transfer and Coordination

• Handle payer transfers, ensuring authorization are updated and aligned with the new payer requirements.
• Verify coverage details and authorization rules during payer change to maintain uninterrupted services.

Expired Reports and Requesting Authorization

• Manage expired authorization report, identify discrepancies and take corrective action.
• Track and resolve authorization issues that may effect billing, scheduling , or services.
• Communicate with branches regarding or pending authoriztion and require next step.

Branch Support and Communications

• Providing guidance and support related to authorization, documents and intake process.
• Respond to branch inquiries promptly and collaborate to resolve authorization or documents issues.
• Communication clearly and professionally via email and internal systems keep all parties informed.

Quality Assurance and Compliance

• Ensure all process comply with payor guidelines, company policies and regulatory standards.
• Identify errors or discrepancies and take corrective action to maintain data integrity.
• Support workflow efficiency by proactively addressing issues before they impact patient care or operations.

Key Strengths/Requirements in the Role

• Strong attention to detail accuracy in documents and data entry.
• Effective communication and collaborations with branch teams.
• Ability to manage high volume of authorization and deadlines.
• Proactive problems-solving to prevent service disruptions
• High school diploma or GED equivalent, some college preferred
• 1-2 years of recent experience working in a health care setting and insurance authorizations
• Excellent written and oral communication skills
• Excellent customer service skills
• Must be computer literate and possesses knowledge of computer software, Microsoft Excel (advance skills preferred), internet, Word and Outlook
• Dependable, conscientious and reliable
• Ability to analyze and interpret situations to complete tasks or duties assigned

Employee wellbeing is top priority at Addus Homecare, and we're thrilled to announce our recognition as the top healthcare company on Indeed's 2024 Top 100 Work Wellbeing Index. View the full rankings here: https://www.indeed.com/employers/work-wellbeing/work-wellbeing-100-ranking.