Business Analyst - Home Care Authorization Specialist

Description

The Authorization Specialist plays a critical role in ensuring timely and accurate authorization of home care services. This position is responsible for verifying patient eligibility, obtaining and tracking authorizations, managing M11Q documentation, and maintaining accurate data within internal systems. The Authorization Specialist works closely with clinical, intake, and billing teams to support seamless service delivery and compliance with regulatory and payer requirements.

What You Will Do

• Accurately enter and maintain patient profile and authorization data, including service order creation or extension, service line updates, diagnosis codes, certification dates, and case documentation in internal systems.
• Obtain, review, and track authorizations to ensure accuracy in service units and timely maintenance of patient records.
• Ensure all authorization information is entered correctly in the system and kept up to date.
• Distribute authorization documents to relevant departments, including care coordinators, finance, and nursing teams, as needed.
• Retrieve and provide physical or electronic copies of authorizations upon request; scan and distribute authorizations to other locations or branches as necessary.
• Verify patient eligibility in ePACES and ensure alignment with received authorizations.
• Cross-check patient details in the CRM system and update HHAeXchange records accordingly.
• Generate and monitor reports in HHAeXchange for expiring authorizations and follow up on missing M11Q documentation.
• Conduct weekly reviews of HHAeXchange pre‑billing reports; escalate discrepancies to the Director of Special Projects and follow through on resolutions.
• Respond promptly to inquiries from the billing department regarding eligibility or authorization issues.
• Communicate service changes to coordinators and the nursing department in a timely manner.
• Maintain a detailed spreadsheet of pending authorizations and eligibility statuses.
• Serve as a point of contact for internal authorization inquiries, providing timely and accurate responses.
• Collaborate closely with operations leaders to clarify authorization details and manage contract case transfers.
• Foster positive working relationships with team members across departments.
• Perform additional duties and projects as assigned.

You Will Be Successful If

• Attention to detail to ensure complete accuracy in documentation, compliance processes, and daily operational tasks.
• Communication skills to convey information clearly and professionally to clients, coworkers, and multiple departments.
• Time management to prioritize and complete responsibilities efficiently in a fast‑paced environment.
• Adaptability to adjust quickly and effectively to changes in priorities, processes, and regulatory requirements.
• Teamwork and collaboration to work productively with colleagues across departments to support high‑quality care and smooth operations.
• Cultural competence to demonstrate respect for and understanding of diverse backgrounds, perspectives, and values.
• Problem‑solving ability to identify issues, analyze root causes, and recommend or implement effective solutions.
• Professionalism and integrity to consistently uphold ethical standards, maintain confidentiality, and demonstrate accountability in all interactions.
• Compliance awareness to understand and apply HIPAA, Department of Health, and agency regulations in daily work.

What You Will Bring

• Minimum of 1‑2 years of experience in a healthcare or home care setting, with a focus on authorizations, eligibility verification, or medical documentation
• Knowledge of M11Q forms, insurance authorization processes, and payer requirements (e.g., Medicaid, MLTCs, Medicare)
• Excellent attention to detail and organizational skills, with the ability to manage multiple tasks and meet strict deadlines
• Strong communication skills, both written and verbal, with the ability to work collaboratively across departments
• Proficiency in Microsoft Office applications, particularly Excel and Outlook
• Ability to maintain confidentiality and handle sensitive patient information in compliance with HIPAA regulations
• Bilingual skills (e.g., Spanish, Russian, or Mandarin) are a plus, depending on the patient population served
• Familiarity with home care software platforms such as HHAeXchange is strongly preferred

About Impresiv Health

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That's Impresiv!