Remote Prior Authorization Specialist (Home Health & Hospice)

Pinnacle Senior Living; United States; Hybrid; USD 32,000 - 39,000; Full time

Benefits offered by this job

Medical, Dental, Vision insurance

Health concierge services

FSA and HSA accounts

Life and AD&D insurance

Sick leave, Holidays, and PTO

Professional growth opportunities

Room for advancement

Supportive, inclusive teammates/leads

Job summary

Alpha Home Health & Hospice is seeking an Insurance Prior Authorization Specialist for on-site work in Mount Vernon, WA or remote work in PST/MST zones. The role focuses on verification of insurance coverage, obtaining authorizations, and accurate data entry within HCHB, with a strong emphasis on customer service and team collaboration.

The position requires at least 1 year of prior authorization/billing experience in home health/hospice, and familiarity with Home Care Home Base.

Qualifications

• Must have at least 1 year of insurance authorization/billing experience in home health/hospice.
• Experience with Home Care Home Base is required.
• Prefer onsite but will consider remote if candidate lives in PST or MST time zones.
• Demonstrated cooperation and excellent customer service skills.
• Ability to multi-task and stay on task in a fast-paced office.
• Excellent team-oriented, verbal, and written communication skills.

Responsibilities

• Verify insurance coverage, including primary and secondary payors.
• Use UGS/DDE and EDS programs to verify Medicare/Medicaid eligibility.
• Obtain visit authorization via payor by providing appropriate medical records.
• Perform accurate data entry in patient records within HCHB.
• Maintain payor files with up-to-date requirements to obtain/initiate appeals for denied authorizations.
• Interface with contract, clinical, and office staff to foster collaboration and positive working relationships.
• Prepare patient co-pay estimates and notify scheduling of authorized visits.
• Provide excellent customer service to patients, referral sources, and community contacts with questions regarding payor prior authorizations and medical guidelines.
• Enter, audit, and follow up on authorized and unauthorized visits within HCHB

Skills

Customer service

Multi-tasking

Verbal communication

Written communication

Team cooperation

Tools

Home Care Home Base

Job description

Alpha Home Health & Hospice is seeking an Insurance Prior Authorization Specialist for on-site work in Mount Vernon, WA or remote work in PST/MST zones. The role focuses on verification of insurance coverage, obtaining authorizations, and accurate data entry within HCHB, with a strong emphasis on customer service and team collaboration.

The position requires at least 1 year of prior authorization/billing experience in home health/hospice, and familiarity with Home Care Home Base.