We are seeking a dedicated and detail-oriented Eligibility and Authorization Specialist to join our home health team. The ideal candidate will possess a strong understanding of managed care processes, medical office procedures, and insurance verification protocols. In this role, you will be responsible for ensuring timely and accurate authorization of services, verifying patient insurance coverage, and maintaining compliance with healthcare regulations such as HIPAA. Your expertise will help facilitate seamless patient care coordination while supporting operational efficiency and regulatory adherence.
Review and process authorization requests for home health services, ensuring all documentation aligns with payer requirements.
Verify patient insurance coverage accurately, including eligibility, benefits, and authorization limits across various managed care plans.
Collaborate with medical providers, case managers, and insurance companies to obtain necessary authorizations and resolve any discrepancies.
Maintain detailed records of all authorization activities in accordance with HIPAA regulations to ensure confidentiality and data security.
Utilize medical coding knowledge, including CPT (Current Procedural Terminology), ICD-9, ICD-10, and ICD coding systems, to support accurate documentation and billing processes.
Assist in the review of medical records to confirm that documentation supports the services being authorized.
Stay informed about changes in insurance policies, managed care guidelines, and healthcare regulations to ensure ongoing compliance.
Proven experience in managed care or medical office settings, preferably within home health or outpatient services.
Strong knowledge of medical terminology, medical records management, and medical coding practices including CPT, ICD-9, ICD-10, and ICD coding systems.
Familiarity with HIPAA regulations to ensure patient privacy and data security at all times.
Experience with insurance verification and authorization processes across various insurance providers and managed care plans.
Office experience that demonstrates organizational skills and attention to detail in a fast-paced environment.
Knowledge of dental office procedures is a plus but not required; however, familiarity with healthcare billing or coding is essential.
Excellent communication skills for effective collaboration with healthcare providers, insurance companies, and patients. Join our team to play a vital role in streamlining the authorization process for home health services while ensuring compliance with healthcare standards and delivering exceptional support to patients and providers alike!
Health insurance
Work Location: In person
Affinity Healthcare Solutions Skilled Care, LLC is a CHAP accredited, Medicare Certified home health agency. We serve clients throughout Philadelphia, Montgomery, Delaware, Chester, Bucks and Lehigh county. The Affinity team is looking for reliable, compassionate healthcare professionals to provide high-quality care to our clients.
