Authorization Services Manager chez Myfamilyfirsthc
Myfamilyfirsthc · Houston, États-Unis d'Amérique · Onsite
- Professional
- Bureau à Houston
About Family First
Family First Homecare provides exceptional homecare services to children with life-long health conditions. We live by our values of telling the truth, owning the details, and raising the bar, working hard to make your job an experience that you enjoy every day. Family First gives you the support you need to do your best work and provide exceptional one-on-one care to your patients in the comfort of their homes. Join us become a part of our family and the families you care for.
The Manager, Authorization Services will lead a team of Authorization Specialists. Responsibilities include overseeing the process of securing and maintaining payor authorizations for medically necessary home health services. The team's primary focus will be on Medicaid and managed Medicaid plans across several states. The Manager will ensure the team meets performance standards for timeliness, accuracy, and compliance, which is crucial for efficient claims submission and reimbursement.
The Manager will serve as the key liaison, and will bridge communication between agency office teams, clinical leadership, and payor representatives. A high level of expertise in Medicaid authorization processes will be vital in resolving escalated issues, ensuring uninterrupted care for our patients.
This role requires a leader with strong problem-solving skills and a commitment to operational excellence. Your work directly supports the delivery of essential services to patients with complex medical needs.
Family First Homecare team members represent the organization and its services in a competent, professional and responsive manner while maintaining standards of high-quality patient care and customer service in accordance with all state, local and federal requirements, rules and regulations.
KEY RESPONSIBILITIES
Team Leadership & Oversight
- Supervise, coach, and develop Authorization Specialists, providing training on Medicaid, managed care, and commercial payor requirements.
- Assign workloads, monitor productivity, and set priorities to ensure authorizations are obtained and renewed within payor timelines.
- Conduct regular one-on-one and team meetings to review performance, address challenges, and share updates on payor policy changes.
Authorization Process Management
- Oversee end-to-end authorization workflows, ensuring complete and accurate submissions in KanTime EMR or payor portals.
- Maintain a high standard of accuracy for clinical documentation and other required information to secure approvals.
- Proactively track expiring authorizations and coordinate with agency office teams to prevent lapses in coverage.
- Serve as the escalation point for complex or disputed authorization cases, working directly with payor representatives to resolve issues.
Compliance & Quality Assurance
- Ensure all authorization activities comply with federal and state Medicaid regulations, HIPAA, and internal policies.
- Monitor key performance indicators (KPIs) for authorization turnaround times, approval rates, and denial trends.
- Identify process improvements to reduce delays and denials, collaborating with the Revenue Cycle and Clinical teams to implement solutions.
Collaboration & Communication
- Partner with agency office leaders to align authorization efforts with patient scheduling and plan of care requirements.
- Provide timely updates to leadership on authorization status for high-priority or at-risk cases.
- Build and maintain strong relationships with payor representatives to support efficient resolution of issues.
Other Duties
- Stay informed of industry trends, payor policy changes, and state-specific Medicaid rules impacting authorizations.
- Participate in special projects or cross-functional initiatives as assigned
- Performs other related duties as assigned
Systems and portals used include but are not limited to the following: Demonstrated proficiency and the ability to train team members with the following system.
- Kantime - EMR
- Availity Clearing House – All States
- HHAeXchange – All States
- Tellus - FL
- Carecentrix
- Medtrac
- Sunshine
- CMS
- Humana
- Keystone
- Aetna Better Health
- Simply
- Coastal Care
- Molina
- BCBS
- Tricare
- VA
- Cigna
ROLE QUALIFICATIONS
EDUCATION & EXPERIENCE
REQUIRED
- Associate’s degree in healthcare administration, business, or related field; OR equivalent work experience considered.
- Minimum 3 years of experience in healthcare authorizations, insurance verification, or revenue cycle, with at least 1 year in a lead or supervisory role.
- Strong knowledge of Medicaid and managed care authorization processes, preferably in home health or pediatric care.
- Experience working with EMR systems and payor portals
PREFERRED
- Bachelor's degree
- Experience working with KanTime
- Leadership and team management skills, with the ability to motivate and develop staff.
- Excellent organizational skills with the ability to manage multiple priorities in a fast-paced environment.
- Strong problem-solving skills and ability to handle escalations effectively.
- Clear, professional communication skills—both verbal and written.
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
WORKING CONDITIONS/EQUIPMENT USE
- Work is performed indoors in a typical office environment - not substantially exposed to adverse environmental conditions.
- Valid driver license with proof of insurance.
- Must be able to lift up to fifteen (15) pounds.
- Frequent use of office machines to include telephone, computer, and printer.
JOB DESCRIPTION DISCLAIMER:
This job description is an overview of the duties and responsibilities assigned to the role identified below. It is not intended to cover every work assignment the job may have, but rather to cover those work assignments which are essential, predominant, and recurring. Responsibilities and duties may change, or new ones may be assigned at any time, with or without notice.
PAY PHILOSOPHY:
The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Family First Homecare have a corresponding compensation plan which may include a bonus at rates that vary based on multiple factors set forth in the compensation plan for the role.
KEY DETAILS:
**This position requires the employee to work in the office Monday through Friday during core business hours.** Core business typically fall between 8:00 am to 5:00 pm with some flexibility with start and end times.
We value your hard work, integrity and commitment to providing the highest quality care to our patients and the communities we serve. We put people first by offering you benefits that support your life and well-being. Below you will find a snapshot of the benefits that you enjoy as part of your role:
- Private Health Care Plans: (Medical, Dental, Vision and Health Savings Account (HSA) with an employer matching contribution
- Voluntary Benefits: (Accident Insurance, Critical Illness, Hospital Insurance, Additional Voluntary Life Insurance, Long-Term and Short-Term Disability)
- 401(k) Retirement Plan and Company Matching Contributions
- Paid Time Off (PTO)
- Paid Holidays
- Employee Assistance Program (EAP) for Employee and Family
- Weekly pay with direct deposit
- myFlexPay – Payroll card allowing you to have your wages deposited directly on to your card
- W2 employee
- Professional development with a rapidly growing organization
- Opportunities for promotions and upward mobility
- Employee Referral Bonus Program
- *Eligibility requirements apply.
Family First Homecare is an equal opportunity employer. We will not tolerate discrimination on the basis of race, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran’s status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
#UPint
Family First HomeCare, LLC is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status, or any other characteristic protected by federal, state, or local law. Family First HomeCare complies with applicable state and local laws governing nondiscrimination in employment. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
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