Intake & Authorization Specialist

Intake & Authorization SpecialistBrightStar Care of Columbus | Columbus, Ohio | Full-Time, In-Office$23.00 – $26.00 per hour, based on experience | Full benefits package About the RoleBrightStar Care of Columbus is looking for an experienced, people-first Intake & Authorization Specialist to be the front door of our agency. This is the person every new client, family member, and referral source talks to first, and the person who makes sure each case is verified, authorized, and ready to staff before care begins.This role is broader than a traditional intake coordinator. In addition to gathering referral information and building a great first impression, you will own insurance verification, prior authorizations, and reauthorizations across every payor we serve: Ohio Medicaid waiver programs, managed care plans, the VA, workers’ compensation, commercial insurance, long-term care insurance, and private pay. You need to understand how authorizations work, which service codes and units go with which payor, and how to keep authorizations current so care never lapses and claims get paid.You will be the primary owner of intake for the agency, working closely with our clinical leadership, care coordinators, and billing team.What You’ll DoIntake & Referral Management•     Receive and respond to referrals from hospitals, physician offices, case managers, Area Agencies on Aging, managed care plans, and families; be warm, responsive, and professional on every call.•     Gather complete client, clinical, and payor information; know the right questions to ask each referral source depending on payor type.•     Determine service eligibility, network status, and coverage before accepting a case; explain coverage, costs, and next steps clearly to clients and families.•     Enter and maintain accurate client and payor records in our agency management system and coordinate hand-off to clinical and scheduling staff for start of care.•     Track referral sources and outcomes to support our sales and business development team.Insurance Verification & Authorizations•     Verify benefits and eligibility for all payor types (Medicaid waiver, managed care, VA, workers’ comp, commercial, LTC insurance, private pay) via payor portals, phone, and clearinghouse tools.•     Obtain initial prior authorizations, ensuring the correct service codes, modifiers, units, and date spans are requested for each payor.•     Monitor authorization utilization and expiration dates; submit reauthorizations ahead of deadlines so services are never interrupted.•     Follow up on pending, denied, or partially approved authorizations; escalate and appeal when appropriate.•     Communicate authorization status and changes to care coordinators, clinical staff, and billing; flag any case where services would exceed authorized units.•     Maintain organized, audit-ready documentation of all verification and authorization activity.What We’re Looking ForRequired•     2+ years of experience in home care, home health, hospice, or another healthcare setting performing intake, insurance verification, or prior authorization work.•     Working knowledge of the authorization process and the service/billing codes used in home care (e.g., HCPCS/CPT, waiver service codes, units, and modifiers).•     Familiarity with multiple payor types; experience with Ohio Medicaid waiver programs (PASSPORT, MyCare Ohio, Ohio Home Care Waiver, DODD), managed care plans, VA, or workers’ compensation is strongly preferred.•     Personable, patient, and clear on the phone with clients and families who may be stressed or unfamiliar with their benefits.•     Highly organized with strong follow-through; comfortable managing many open items with hard deadlines.•     Proficient with payor portals, EHR/agency management software, and Microsoft Office; able to learn new systems quickly.•     Understanding of HIPAA and confidentiality requirements.•     High school diploma or equivalent required.Nice to Have•     Experience with Ohio Medicaid managed care and MyCare Ohio plans (e.g., CareSource, Molina, Buckeye, Aetna, Anthem, Humana) and Ohio BWC/MCO workers’ compensation authorizations.•     Experience with commercial and LTC insurance verification (e.g., network status, benefit exclusions, LTC claim intake).•     Associate degree or certification in medical billing/coding, health information, or a related field preferred.Schedule, Pay & Benefits•     Full-time, Monday through Friday, in our Columbus office (this is not a remote position).•     $23.00 – $26.00 per hour, based on experience.•     Full benefits package, including health insurance benefits, paid time off, and paid holidays.•     Stable, established employer: locally owned and operated since 2008.About BrightStar Care of ColumbusBrightStar Care of Columbus is a locally owned, Joint Commission-accredited home care agency serving Franklin County and the surrounding counties since 2008. We provide skilled nursing and non-skilled personal care to clients across a wide range of payors, including Ohio Medicaid waiver programs, MyCare Ohio, Franklin County Senior Options, DODD, OhioRISE, the VA, workers’ compensation, commercial insurance, and private pay. Our team is known for clinical quality, responsiveness, and genuine care for the people we serve.BrightStar Care of Columbus is an Equal Opportunity Employer. Employment is contingent on a background check in accordance with Ohio home care regulations.