Pure Home Healthcare

LLC 3800

Poplar Hill Rd., Chesapeake, VA 23321 Full-Time | Monday-Friday | 9:00 AM-5:00 PM Pure Home Healthcare LLC is seeking a detail-oriented and experienced Home Healthcare Authorization Specialist to join our team. The ideal candidate will have previous experience obtaining and maintaining healthcare authorizations and be familiar with insurance portals and Managed Care Organizations (MCOs).

POSITION RESPONSIBILITIES

Submit and obtain home healthcare service authorizations through MCOs, Medicaid, Medicare, and commercial insurance plans. Complete authorization requests accurately and within required deadlines. Submit clinical documentation and supporting information as required by payers. Monitor authorization status, expiration dates, approved units/hours, and service periods. Follow up with MCOs and insurance companies regarding pending, denied, or incomplete authorizations. Review authorization approvals to ensure services, units, dates, and member information are accurate. Communicate authorization updates to management, clinical staff, scheduling, and other appropriate departments. Maintain organized and accurate authorization records. Assist with renewals, extensions, reconsiderations, and appeals when necessary. Verify member eligibility and insurance coverage when needed. Identify authorization issues that could affect service delivery or billing and communicate them promptly. Maintain confidentiality and comply with HIPAA and company policies. Perform other administrative duties related to healthcare authorizations as assigned. ✅

REQUIRED QUALIFICATIONS

Minimum 1 year of prior healthcare authorization experience required. Home healthcare, home health, personal care, Medicaid, or MCO experience strongly preferred. Experience submitting authorizations through Availity required. Familiarity with Medicaid/MCO portals and insurance verification. Strong understanding of authorization processes, service units/hours, and authorization periods. Excellent attention to detail and organizational skills. Ability to manage multiple authorizations and deadlines simultaneously. Strong written and verbal communication skills. Proficient with computers, email, Microsoft Office, and electronic healthcare systems. Ability to work independently while also functioning effectively as part of a team. Must maintain strict confidentiality of patient/member information. ⭐

PREFERRED EXPERIENCE

Experience with Virginia Medicaid and Virginia MCOs is highly preferred, including familiarity with organizations such as Sentara Health Plans, Aetna Better Health, UnitedHealthcare, Anthem HealthKeepers Plus, and other Virginia Medicaid managed-care plans.

WHAT WE'RE LOOKING FOR

We are looking for someone who is organized, dependable, proactive, and knowledgeable about healthcare authorizations. The right candidate understands that timely and accurate authorizations are essential to ensuring our members receive uninterrupted care.

Employment Type:

Full-TimeSchedule:

Monday-Friday, 9:00 AM-5:00

PMLocation:

3800 Poplar Hill Rd., Chesapeake, VA 23321

Pay:

$16.00 - $18.00 per hour

Benefits:

401(k) 401(k) matching Paid time off Referral program Retirement plan

Work Location:

In person