Authorization Specialist – Managed Care

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Limitlessli

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

🎯 Recruiter

☁️ SaaS

Healthcare Insurance • Recruitment • SaaS

Limitlessli is a company that specializes in providing offsite staffing solutions for healthcare facilities. They offer customized staffing services for clinical and non-clinical roles, aiming to reduce operational costs and enhance efficiency. With a focus on remote staffing, Limitlessli supports healthcare operations by ensuring compliance with CMS, DOH, and other regulatory agencies through their Active Review Protocols (ARPs™). They provide MDS consulting services and cater to a wide array of healthcare settings including skilled nursing facilities, home healthcare, urgent care centers, and telehealth, among others. Their solutions are designed to increase ROI, offer scalable staffing options, and minimize stress for their clients.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• Essential tools – a reliable computer and noise-canceling headset • A second monitor for enhanced productivity • A stable internet connection • Backup internet connection for seamless work