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BrightStar Care of Plano / North Dallas

Authorization Specialist

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What they do

An Eligibility Specialist provides assistance and information for people who apply for a government benefits program or health care program. Answers questions, assists with an application process, and reviews applications and relevant background information to determine eligibility. May assist eligible applicants with enrolling in a program.

$46,315 / year median in Texas

+19% projected growth

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Job Description

Authorization Specialist BrightStar Care of Plano / North Dallas - 2.4 Richardson, TX Job Details Full-time $21 - $24 an hour 21 hours ago Benefits Health insurance Dental insurance Paid time off Vision insurance Qualifications Medical insurance coverage verification High school diploma or
GED Full Job Description Benefits:
Health insurance Paid time off Training & development Vision insurance Dental insurance Purpose of the Role The Authorization Specialist is responsible for ensuring timely and accurate insurance verifications and obtaining authorizations for home health services. This role is critical in facilitating seamless patient care by securing required approvals and communicating effectively with insurance providers, clinical staff, and patients. Key Responsibility Areas (KRAs)
Responsibility:
Verify patient insurance benefits and eligibility for home health services.
Performance Standard:
Measurement Criteria:
Responsibility:
Obtain initial and ongoing authorizations for skilled nursing, therapy, and other clinical services as required by payers.
Performance Standard:
Measurement Criteria:
Responsibility:
Submit documentation to insurance companies to support authorization requests.
Performance Standard:
Measurement Criteria:
Responsibility:
Monitor and track authorization status, renewals, and expiration dates.
Performance Standard:
Measurement Criteria:
Responsibility:
Communicate authorization approvals, denials, and requirements to clinical staff and administrative teams.
Performance Standard:
Measurement Criteria:
Responsibility:
Collaborate with intake, billing, and clinical departments to ensure alignment and accuracy in patient care and billing.
Performance Standard:
Measurement Criteria:
Responsibility:
Maintain up-to-date knowledge of payer-specific requirements and changes in insurance regulations.
Performance Standard:
Measurement Criteria:
Responsibility:
Document all authorization activities accurately in the electronic medical record (EMR) and/or billing systems.
Performance Standard:
Measurement Criteria:
Responsibility:
Resolve insurance-related issues promptly to avoid delays in care or billing interruptions.
Performance Standard:
Measurement Criteria:
Responsibility:
Assist in appeals processes for denied authorizations as needed.
Performance Standard:
Measurement Criteria:
Responsibility:
Support cross-training initiatives and assist with special projects as assigned
Performance Standard:
Measurement Criteria:
Core Competencies & Behaviors Accuracy & Detail Orientation:
Carefully reviews payer requirements and inputs data with precision
Communication:
Clearly conveys complex insurance information to staff and payers
Customer Focus:
Provides responsive support to internal teams and patients regarding coverage issues
Adaptability:
Responds effectively to frequent changes in payer guidelines and agency procedures
Teamwork:
Works collaboratively with intake, billing, and clinical teams to coordinate patient care
Accountability:
Follows through on open tasks and meets timelines for authorizations Education and Experience High school diploma or equivalent required; associate's degree preferred Minimum 2 years of experience in insurance verification or authorization, preferably in home health or healthcare setting Knowledge of commercial payer authorization processes Experience using EMR or home health software systems Familiarity with HIPAA and healthcare documentation standards Review Cycle & Feedback Failure to meet performance expectations may subject the employee to disciplinary action up to and including termination. Working Conditions & Physical Requirements This position operates in a professional office environment. The employee routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets. The role primarily involves sedentary work, including prolonged periods of sitting, frequent use of hands for typing, and regular communication via phone and email. Minimal lifting of materials (typically under 10 pounds) may occasionally be required. Regular, predictable attendance is required. Reasonable accommodations may be made to enable individuals with disabilitie