Authorization Specialist

About the role

The Authorization Specialist at Avid Health is responsible for obtaining and managing insurance authorizations for home care services. This role ensures timely coordination with payers and compliance with regulatory and payer requirements. The specialist acts as a key liaison among operational teams and insurance providers to secure approvals and avoid delays in care.

Responsibilities

• Obtain prior authorizations and recertifications for home care services from insurance providers (Medicaid, Managed Care, and commercial plans).
• Submit authorization requests accurately and follow up to ensure timely approvals or denials.
• Monitor authorization status and track expiration dates to prevent lapses in authorization.
• Communicate authorization outcomes to operational staff and leadership.
• Resolve authorization issues and denials, including coordinating appeals and additional documentation when needed.
• Maintain accurate records in the electronic medical record (EMR) and billing systems.
• Ensure compliance with federal, state, and payer-specific regulations and guidelines.
• Collaborate with revenue cycle and operational teams to streamline workflow and improve authorization turnaround times.
• Identify trends in denials or payer issues and escalate appropriately.

Requirements

• High school diploma or equivalent (Associate or Bachelor’s degree preferred).
• Minimum 1–3 years of experience in healthcare authorization or revenue cycle (home care or home health preferred).
• Strong knowledge of Medicaid, and managed care authorization processes.
• Experience with North Carolina, Illinois, Michigan, Kentucky and/or Ohio a plus.
• Familiarity with medical terminology and home care services.
• Experience working with EMR systems and insurance portals.
• AlayaCare experience a plus.
• Excellent organizational skills and attention to detail.
• Strong communication and problem-solving abilities.

Benefits

• Competitive pay, paid biweekly.
• Paid Time Off.
• 401k plan with company match.
• Medical Insurance (choice of 3 plans), with company contribution.
• Dental Insurance.
• Vision Insurance.
• Life and AD&D Insurance.
• Short and Long-Term Disability Insurance.
• Holiday Pay.
• Ongoing training.
• Performance based bonus.

Employer Information

Employer is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.