Home Health Prior Authorization Specialist

Description:

We are looking for an experienced Home Health Prior Authorization Specialist to support a U.S.-based Home Health Agency. The ideal candidate must have hands-on experience with U.S. home health intake, insurance verification, prior authorization processing, and payer portal management. The candidate should be familiar with major U.S. insurance providers, authorization requirements, and home health EMR systems.

This is an onsite position based in Model Town, Lahore, working during U.S. business hours.

Key Responsibilities

• Verify patient insurance eligibility, benefits, and home health coverage.
• Review referral details and clinical documentation to determine authorization requirements.
• Submit and manage prior authorization requests for home health services.
• Work with insurance portals to submit requests, check authorization status, and obtain approvals.
• Follow up with insurance companies regarding pending, denied, or incomplete authorization requests.
• Handle authorization denials, reconsiderations, and appeals where required.
• Coordinate with intake teams, physicians, referral sources, and clinical staff to obtain missing documentation.
• Ensure authorization details, approved services, visit limits, and validity periods are accurately recorded.
• Maintain updated records of submitted, pending, approved, and denied authorizations.
• Identify and escalate authorization delays that may affect patient admission or Start of Care (SOC).
• Maintain accurate documentation while complying with HIPAA and agency requirements.

Required Qualifications & Experience

• Hands-on experience in U.S. Home Health Intake and Admissions.
• Practical experience with insurance verification and prior authorization processing.
• Hands-on experience with insurance portals, including:
• Availity, UHC, Cohere, Carelon, UMR, Palmetto, and Waystar.
• Hands-on experience with Home Health EMR systems, including:
• Alora, Kinnser, and KanTime.
• Working knowledge of Medicare, Medicare Advantage, Medicaid, and commercial insurance processes.
• Understanding of home health referrals, physician orders, clinical documentation, and Start of Care (SOC) requirements.
• Strong written and verbal English communication skills.
• Excellent multitasking, organizational, follow-up, and problem-solving skills.
• Ability to manage multiple time-sensitive authorization requests accurately.