Authorization Specialist - Managed Care

We are seeking a detail-oriented and proactive Authorization Specialist to join our Managed Care team at a Skilled Nursing Facility in Pennsylvania. This role is responsible for obtaining, monitoring, and managing insurance authorizations for residents receiving skilled nursing and rehabilitation services. The ideal candidate will work closely with clinical, admissions, and payer representatives to ensure timely approvals, accurate documentation, and uninterrupted coverage throughout the patient's stay.

This is a fully remote position

• →Obtain initial and continued stay authorizations from Managed Care Organizations (MCOs), Medicare Advantage plans, and other third-party payers.
• →Monitor authorization status, track expiration dates, and submit timely extension requests to prevent coverage gaps.
• →Collaborate with nursing, therapy, admissions, and case management teams to gather clinical documentation required for authorization requests.
• →Maintain accurate authorization records and supporting documentation within the facility's systems.
• →Communicate with insurance companies regarding authorization determinations, requests for additional information, and coverage updates.
• →Review payer requirements and ensure compliance with authorization guidelines and policies.
• →Escalate authorization denials and coordinate with appropriate teams to support reconsiderations or appeals.
• →Assist in identifying authorization-related trends, issues, and opportunities for process improvement.
• →Support revenue cycle objectives by helping ensure services are authorized and reimbursable.

• Minimum 3–4 years of experience in healthcare insurance authorization, utilization review, managed care, admissions, or related healthcare revenue cycle functions.
• Experience working with Skilled Nursing Facilities (SNFs), rehabilitation services, long-term care, or post-acute care settings preferred.
• Knowledge of Managed Care, Medicare Advantage, Medicaid Managed Care, and commercial insurance authorization processes.
• Strong understanding of medical terminology and clinical documentation requirements.
• Excellent organizational skills with the ability to manage multiple authorizations and deadlines simultaneously.
• Strong verbal and written communication skills.
• Proficiency with electronic health records (EHRs), payer portals, and Microsoft Office applications.
• Ability to work independently while collaborating effectively with interdisciplinary teams.

You will need to have some essential tools – a reliable computer and noise-canceling headset, a second monitor for enhanced productivity, and a stable internet connection. You’ll also be required to have a backup internet connection, ensuring that you’re well-equipped to complete your work seamlessly.

US Hours EST - 9am to 6pm

We embrace the flexibility and convenience of a remote working environment, and you will collaborate with an international team while contributing to our growing business, all from the comfort of your home.