Authorization Specialist - Home Care Agency (On-Site)

YELM US Associates is the administrative division supporting our licensed home care agencies, Ultimate Care and Swift Home Care.

Position Details

• Compensation: $25–28 per hour, based on relevant experience
• Location: 1000 Gates Avenue, 4th Floor, Brooklyn, NY 11221
• Schedule: Monday–Friday, 9:00 AM–5:00 PM, onsite
• Reports to: Director of Authorizations

Responsibilities

• Process and track authorizations for home health services, ensuring timely submission to insurance providers.
• Review patient records and treatment plans to ensure all required documentation is complete and accurate.
• Communicate with insurance companies to secure necessary authorizations for services.
• Communicate with insurance companies regarding revised authorizations (fax time/sheets) and other requested documents.
• Manage and resolve issues related to denied or delayed authorizations, including re‑submissions or appeals.
• Maintain detailed and accurate records of all authorization activities.
• Collaborate with clinicians, case managers, and other team members to ensure care plans align with authorization requirements.
• Stay updated on changes in insurance policies, billing codes, and regulatory requirements related to home care.
• Provide exceptional customer service to both internal and external stakeholders, ensuring clear and efficient communication.
• Weekly review of admissions, discharges, and temp auth reports.
• Monitor payer portals and follow up on branch/Intake requests.
• Notify teams of changes in authorization (e.g., termination, holds, hospitalizations, increases, decreases).
• Verify eligibility the first business day of the month and the 15th for flagged known potential issues; reach out to all insurances via email/phone regarding potential termination or continuation of services.
• Monitor the HHAEX Board (accept or deny cases).
• Monitor/review payor messages on the Home screen, update HHAEX, and advise Placement of any changes accordingly.
• Run reports from HHAEX (Temp Report, Authorizations due by Date Report, Authorizations Report).
• Create profiles for new members in HHAEX.
• Merge profiles so all clinical documents are kept in one place.
• Monitor mail (some contracts still send authorizations via mail).

Qualifications

• Minimum 1 year experience working in an authorizations‑related role in a home care agency.
• Proficiency with HHA eXchange.
• Proficiency with Excel.
• Strong organizational, critical thinking, and problem‑solving skills with attention to detail.
• Ability to take initiative, initiate appropriate follow‑up, and complete tasks thoroughly and accurately.
• Effective communication and interpersonal skills, enabling rapport with clients, caregivers, and healthcare professionals.
• Ability to work in a collaborative environment across departments.

Education

High school diploma or equivalent required.

Benefits

• Paid Time Off
• Medical, Vision, and Dental coverage
• 401(k) retirement plan with employer match
• Voluntary Life, Critical Illness, Group Hospital Indemnity, and Accident insurance

About Us

Our mission is to provide and restore client dignity and independence in their homes through individualized care plans that reduce caregiver role strain and stress on family members while helping clients avoid nursing homes and assisted living facilities. YELM US Associates LLC is a licensed home care provider offering comprehensive home care services. We lead with our hearts to deliver top‑quality, compassionate, and empathetic care.

At Ultimate Care, we are dedicated to fostering a people‑centric culture that is pivotal for success in the contemporary home care landscape. Our unwavering commitment begins with inspiring and empowering our employees to unleash their full potential. We actively pursue avenues to cultivate a dynamic learning environment, allowing our team members to explore and nurture their passions and talents. Our goal is to facilitate holistic growth, both personally and professionally, whether within the office or beyond. Join us on this journey of empowerment and achievement!