Authorization Specialist - Care and Help Home Care : Job Details

About Care & Help Choosing home care services in Philadelphia can be a difficult and uncertain decision. Care & Help Home Care, LLC is a trusted home healthcare provider within the Philadelphia area that is committed to providing home care services that are transparent, professional, and excellent. Our large staff of caregivers and home health aides are experienced and screened to be able to provide non-skilled and non-medical services for seniors. Job Summary: The Authorizations Specialist plays a critical role in obtaining and managing authorizations for home care services provided to clients. This individual will be responsible for entering authorizations into the system, following up on missing authorizations, and ensuring that all necessary authorizations are obtained before billing. The Authorizations Specialist will work closely with internal operations, and external healthcare providers, and insurance companies to facilitate the authorization process efficiently and accurately. Essential Duties and Responsibilities:

• Review and enter authorizations for home care services into the appropriate systems or databases accurately and promptly.
• Follow up on missing authorizations by contacting operations, clients, insurance companies, and healthcare providers to obtain the necessary documentation.
• Monitor the status of authorizations & eligibility timely and follow up with insurance companies and healthcare providers as needed to expedite the approval process.
• Coordinate with the billing department to ensure that all authorized services are billed accurately and in a timely manner.
• Communicate with operations regarding the status of client authorizations and provide assistance with any authorization-related questions or concerns.
• Maintain detailed and accurate records of all authorizations, including documentation of communications and follow-up activities.
• Assist with researching payments received from insurance companies as it relates to billing denials for authorization or eligibility items

Qualifications and Skills: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• High school diploma or equivalent required; associate or bachelor's degree preferred.
• Minimum of 1-2 years of experience in a healthcare-related role, with specific experience in authorizations preferred.
• Strong organizational skills and attention to detail, with the ability to manage multiple tasks and priorities simultaneously.
• Excellent communication skills, both written and verbal, with the ability to interact professionally with clients, healthcare providers, and insurance company representatives.
• Proficiency in using computer systems and software applications, including electronic medical records (EMR) systems and Microsoft Office Suite.
• Ability to work independently with minimal supervision and make sound judgments based on established guidelines and procedures.
• Knowledge of medical terminology, insurance terminology, and billing processes preferred.

Physical Demands:

• Prolonged periods of sitting at a desk and working on a computer.
• Prolonged periods of standing, bending, and reaching
• Must be able to lift up to 50 pounds at times.

Work Environment:

• On-site / Hybrid

ABOUT CARE AND HELP HOME CARE, LLC CARE AND HELP HOME CARE, LLC ( Company ) provides non-skilled services to individuals in their homes or other independent living environments. These services include (but are not limited to) assistance with self-administration of medications, personal care such as assistance with personal hygiene, dressing, and feeding, homemaking such as assistance with household tasks housekeeping, shopping, meal planning and preparation, and transportation, companionship, respite care such as assistance and support provided to the family; and other non-skilled services. We conduct criminal background checks when required on all staff. We also conduct physicals and tuberculosis screenings for all direct care workers and office staff with direct consumer contact upon hiring and on a yearly basis. The direct care workers of the Company are required to complete a minimum of forty (40) hours of experience or practical training and a competency evaluation, or a state certification program. This training includes information regarding personal hygiene, safe transfer techniques, infection control, and basic nutrition. All direct care workers of our company also receive supervised practical training before having direct contact with a consumer or verification of prior experience. CARE AND HELP HOME CARE, LLC ( Company ) does not discriminate on the basis of race, color, national origin, ancestry, religious creed, non-job related handicap or disability, sex (which includes: sex assigned at birth, sexual orientation, gender identity, gender expression, gender transition, or transgender identity), age, use of a guide or support animal because of: blindness, deafness, or physical handicap, or any other characteristic protected by law (each, a Protected Characteristic ). Further, the Company complies with the provisions of the Federal Civil Rights Act of 1964, the Pennsylvania Human Relations Act and all other applicable laws related to discrimination and fair employment practices. Accordingly, no person shall, on the grounds of any Protected Characteristic, be excluded from participation in, be denied benefits of, or otherwise be subject to discrimination in the provision of any care service provided by our agency. DISCLAIMERS The company, in considering your application for employment, may verify the information set forth on this application and obtain additional information related to your background. We offer reasonable accommodations in the hiring and employment process for individuals with disabilities. If you need assistance to accommodate a disability, you may request an accommodation at any time.