Authorization Specialist in Chicago, Illinois at Avid Health at Home

Avid Health delivers exceptional personalized in-home care services by hiring compassionate people who believe in taking care of our clients, fellow employees, and the communities we serve.

We believe in Access, Value-Based Care, Innovation, and Dedication to Quality.

JOIN OUR TEAM!

This position is available immediately!

The Authorization Specialist is responsible for obtaining and managing insurance authorizations for home care services. This role ensures timely coordination with payers and compliance with regulatory and payer requirements. The specialist acts as a key liaison among operational teams and insurance providers to secure approvals and avoid delays in care.

Key Responsibilities

• Obtain prior authorizations and recertifications for home care services from insurance providers (Medicaid, Managed Care, and commercial plans).
• Submit authorization requests accurately and follow up to ensure timely approvals or denials.
• Monitor authorization status and track expiration dates to prevent lapses in authorization.
• Communicate authorization outcomes to operational staff and leadership.
• Resolve authorization issues and denials, including coordinating appeals and additional documentation when needed.
• Maintain accurate records in the electronic medical record (EMR) and billing systems.
• Ensure compliance with federal, state, and payer-specific regulations and guidelines.
• Collaborate with revenue cycle and operational teams to streamline workflow and improve authorization turnaround times.
• Identify trends in denials or payer issues and escalate appropriately.

Performance Indicators

• Authorization turnaround time
• Approval vs. denial rates
• Reduction in authorization-related delays in patient care
• Accuracy of documentation and data entry
• Compliance with payer and regulatory standards

You have a lot to offer! And so do we!

Benefits:

• Competitive pay, paid biweekly
• Paid Time Off
• 401k plan with company match
• Medical Insurance (choice of 3 plans), with company contribution
• Dental Insurance
• Vision Insurance
• Life and AD&D Insurance
• Short and Long-Term Disability Insurance
• Holiday Pay
• Ongoing training
• Performance based bonus

Employer is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

Required Qualifications

• High school diploma or equivalent (Associate or Bachelor’s degree preferred).
• Minimum 1–3 years of experience in healthcare authorization or revenue cycle (home care or home health preferred).
• Strong knowledge of Medicaid, and managed care authorization processes. Experience with North Carolina, Illinois, Michigan, Kentucky and/or Ohio a plus.
• Familiarity with medical terminology and home care services.
• Experience working with EMR systems and insurance portals. AlayaCare experience a plus.
• Excellent organizational skills and attention to detail.
• Strong communication and problem-solving abilities.

Preferred Qualifications

• Experience in a home care, hospice, or home health setting.
• Knowledge of payer-specific guidelines for eligibility, authorization and services.
• Prior experience handling denials and appeals.

Key Competencies

• Detail-oriented with high accuracy
• Time management and prioritization
• Analytical and critical thinking
• Customer service and patient-focused mindset
• Ability to work under deadlines in a fast-paced environment
• Strong collaboration and teamwork

Working Conditions

• Office-based work environment
• Frequent use of computers, phones, and insurance portals
• May require extended periods of sitting