Health Care
- Insurance Authorization Specialist Albemarle, NC 28001 Hybrid work $22
- $28 an hour
- Part-time, Full-time $22
- $28 an hour
- Part-time, Full-time Overview Join our dynamic team at ELW Consulting Services as a Insurance Authorization Specialist!
In this vital role, you will be the key liaison between QP Managers, and Insurance companies to ensure smooth authorization processes for medical services. Your energetic approach and attention to detail will help facilitate timely approvals, streamline office operations, and enhance patient care experiences. If you thrive in a fast-paced environment and are passionate about healthcare administration, this is your opportunity to make a meaningful impact! Position Summary The Authorization Specialist is responsible for obtaining, tracking, monitoring, and maintaining insurance authorizations to ensure uninterrupted service delivery for clients. The Authorization Specialist works closely with QPs, clinicians, Peer Support Specialists, Managed Care Organizations (MCOs), and administrative staff to ensure all required documentation is received, submitted, and approved within required timeframes. The position plays a critical role in preventing gaps in treatment and maintaining compliance with payer requirements. Essential Duties and Responsibilities Authorization Management Submit initial authorization requests, reauthorizations, and extensions to insurance providers and MCOs. Monitor authorization expiration dates and notify appropriate staff of upcoming deadlines. Track pending authorizations and follow up with payers as needed. Maintain accurate authorization records within the EHR and agency tracking systems. Ensure services are not billed without an active authorization. Documentation Review Review submitted documentation for completeness prior to authorization submission. Verify that all required documents are received, including: Comprehensive Clinical Assessments (CCA) Person-Centered Plans (PCP) Service Orders Crisis Plans Progress Notes Signature Pages Releases of Information (ROI) Clinical Summaries Any additional payer-specific requirements Notify QPs and clinical staff immediately of missing, incomplete, or noncompliant documentation. Communication and Follow-Up Maintain ongoing communication with QPs regarding authorization status. Document all requests for missing documentation and follow-up attempts. Provide regular authorization status reports to leadership. Communicate approval, denial, reduction, or request-for-information determinations to appropriate staff. Escalate barriers that may result in service disruption. Compliance and Quality Assurance Ensure submissions meet Medicaid, MCO, CARF, and agency requirements. Maintain confidentiality in accordance with HIPAA and 42 CFR Part 2 regulations. Participate in audits and quality improvement activities. Assist with corrective action plans related to authorization deficiencies. Maintain organized electronic and paper records for audit readiness. Reporting Responsibilities Complete daily authorization activity reports. Track outstanding documentation requests. Maintain logs of pending, approved, denied, and expired authorizations. Report trends contributing to delays in service authorization. Qualifications High School Diploma required; Associate's or Bachelor's degree preferred. Experience in behavioral health, healthcare administration, utilization management, or insurance authorization preferred. Knowledge of Medicaid, MCO authorization processes, and behavioral health services. Strong organizational, communication, and time-management skills. Ability to manage multiple deadlines and priorities. Proficiency with electronic health records and payer portals. Authorization specialists commonly review documentation, submit and track authorization requests, communicate with payers and providers, and maintain accurate records to prevent service delays. Performance Expectations Submit authorizations timely and accurately. Maintain audit-ready documentation. Proactively communicate barriers. Follow up on missing documentation until resolved. Support continuity of care and minimize service disruptions. Maintain professionalism and collaboration with all departments. We are excited to talk with you! Please apply through the Indeed link
Pay:
$22.00
00 per hour
Benefits:
Employee assistance program Flexible schedule Professional development assistance People with a criminal record are encouraged to apply Ability to
Commute:
Albemarle, NC 28001 (Preferred)
Work Location:
Hybrid remote in Albemarle, NC 28001
