The Authorization Specialist is responsible for obtaining, tracking, and verifying all insurance authorizations and approvals for patient admissions, continued stays, and specialty services in a skilled nursing facility (SNF) setting. This role ensures timely and accurate communication with insurance providers, clinical teams, and admissions staff to support appropriate and efficient patient care.
Obtain initial and ongoing authorizations from insurance companies (including Medicare Advantage, Medicaid Managed Care, and commercial plans) for SNF admissions, therapy services, and extended stays.
Verify insurance eligibility and benefits for incoming and current residents.
Maintain detailed and up-to-date records of all authorizations, including approval dates, coverage details, and any limitations.
Collaborate closely with admissions, nursing, case management, and billing teams to ensure seamless coordination of care and documentation.
Communicate with insurance representatives to resolve delays, denials, or discrepancies in coverage.
Ensure timely submission of clinical documentation required for authorization and continued stay reviews.
Monitor re-authorization dates and initiate renewals in advance to avoid service interruptions.
Assist with appeals and denials as needed, gathering documentation and supporting information.
Maintain compliance with HIPAA regulations and all facility policies and procedures.
High school diploma or equivalent (Associate's degree preferred).
Prior experience in healthcare authorization, billing, or admissions—preferably in a SNF, hospital, or managed care environment.
Strong understanding of insurance plans, including Medicare, Medicaid, and commercial payers.
Excellent organizational, time management, and communication skills.
Proficient in basic computer systems and electronic health records (EHR).
Ability to work in a fast-paced environment with strong attention to detail.
Authorization Specialist • Tulare, CA
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