Authorization Specialist

Job Description

REQUIREMENTS

• High School diploma or equivalent with two years of prior authorization experience
• Strong understanding of medical terminology
• Proficiency in Microsoft Office applications and excellent communication skills
• Ability to analyze data and exercise independent judgement
• Familiarity with MCO regulations for Pennsylvania home health aide (HHA) services is preferred

RESPONSIBILITIES

• Managing a team to evaluate and access intakes for program eligibility and to ensure all families’ documentation is collected, completed and submitted to the MCO’s accordingly
• Review and interpret medical records to ensure timely and accurate prior authorizations, helping families avoid unnecessary delays in care
• Maintain high-quality standards and productivity measures in all authorization activities, ensuring families receive the best support
• Collaborate with internal and external partners to enhance customer satisfaction and compliance, protecting families from financial burdens
• Review applications and payor websites to manage prior authorization, edits, denials and appeals efficiently

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