Healthcare Authorization Coordinator

I. About BrightStar Care of Plano:
BrightStar Care of Plano is seeking a dedicated Insurance Verification & Authorization Specialist to join our growing home healthcare team. This role focuses on verifying insurance benefits and securing authorizations for new patients to ensure seamless access to the care they need.

BrightStar Care of Plano is a premier home health company specializing in skilled nursing care, including wound care, infusion therapy, physical therapy, occupational therapy, and more. We are committed to delivering high-quality, patient-centered care to individuals across Northeast Texas, ensuring they receive exceptional medical care in the comfort of their homes.

Our team of skilled professionals works collaboratively with patients, families, and healthcare providers to develop personalized care plans that promote recovery, independence, and quality of life. At BrightStar Care of Plano, we combine clinical excellence with compassion, making us a trusted partner in home healthcare.

II. About the Role:
As an Insurance Verification & Authorization Specialist, you will play a critical role in ensuring that patients receive timely and accurate authorizations for the services we provide. Your efforts will directly support our ability to deliver uninterrupted care while maintaining compliance with insurance policies and regulations.

In this position, you will be responsible for supporting the full cycle of insurance verification and authorization, collaborating with clinical and administrative teams, and maintaining positive relationships with patients and payers.

If you thrive in a fast-paced environment, have a keen attention to detail, and are passionate about helping patients access quality care, we want you on our team!

III. Role Responsibilities:
You will be a key point of contact for all insurance verification and authorization processes, ensuring patients can receive the care they need without administrative delays.

Key Responsibilities:

• Verify insurance benefits and eligibility for new and existing patients, ensuring accuracy and efficiency.
• Submit and track authorization requests for medical services, ensuring approvals are obtained promptly.
• Monitor authorization status and maintain accurate records of visit limits, policy coverage, and expiration dates.
• Communicate effectively with insurance companies to resolve discrepancies, delays, or denied authorizations.
• Collaborate with the clinical team to relay authorization updates and ensure care plans align with payer guidelines.
• Review incoming faxes and digital communications to assess and process new patient requests.
• Ensure compliance with all federal, state, and payer-specific regulations, including HIPAA standards.
• Identify and implement process improvements to enhance the efficiency of the authorization workflow.
• Report key metrics on verification and authorization trends to leadership.

IV. Role Requirements:

Experience:

• 5 years of experience in healthcare insurance verification and authorization.
• 1 year of experience in home health/home care/home infusion insurance verification (preferred).
• Proven ability to navigate commercial insurance and Medicaid processes.
• Experience working with RCM software and payer portals (e.g., Office Ally, Availity).

Technical Skills & Knowledge:

• Strong working knowledge of medical terminology and healthcare billing codes (ICD-10, CPT, HCPCS).
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook).
• Ability to interpret and apply insurance policy guidelines accurately.

Operational Excellence:

• Self-motivated with the ability to manage multiple priorities and meet deadlines.
• Strong communication skills to interact with internal teams, patients, and external payers.
• Detail-oriented approach to tracking authorizations and ensuring accuracy.
• Ability to identify process inefficiencies and recommend improvements.

Soft Skills & Mindset:

• Compassionate and patient-centered mindset with a commitment to quality care.
• Problem-solving mentality with a proactive, solution-driven approach.
• Adaptability to work both independently and as part of a collaborative team.

Preferred Qualifications:

• Experience with home health authorization and eligibility verification.
• Familiarity with Office Ally and Availity platforms.
• Strong Excel skills for tracking and reporting purposes.

V. Additional Details:

Reporting Structure:

• Reports to: Auth Team Lead

Key Performance Indicators (KPIs) & Success Metrics:

• Timely Processing: Ensure all authorization requests are submitted same day and / or in few cases within 24 hours of receipt.
• Accuracy Rate: Maintain a 98% or higher accuracy rate in insurance verification.
• Turnaround Time: Secure authorizations within payer-specified timeframes.
• Compliance: Adhere to all payer regulations and maintain audit readiness.

Work Environment & Location Expectations:

• Work Location: In-office at Plano, TX (75074)
• Schedule: Monday to Friday (Full-time, minimum 40 hours per week)

Compensation & Benefits:

• Pay: $19.00 - $23.00 per hour (based on experience)
• Healthcare, dental, and vision insurance
• Paid time off (PTO)

Job Type:

• Full-time

Work Location:

• In person (Plano, TX 75074)

Required Experience:

• Insurance Verification: 5 years
• Authorizations: 1 year

License/Certification:

• Driver's License (Required)

Job Type: Full-time

Pay: $19.00 - $23.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: In person

Salary : $19 - $23