As a Service Authorization Specialist, you manage service authorizations and maintain accurate records within the ADS program. Responsibilities include coordinating Medicaid/MCO service authorizations for Agency-Directed services, ensuring regulatory compliance, collaborating with RNs and Case Managers to gather documentation, monitoring authorization timelines, verifying insurance coverage including policy details and billing criteria, and communicating with internal teams and external agencies to resolve authorization or credentialing issues.
You will stay updated on Medicaid and MCO regulations and update processes accordingly. This is a hybrid role with some in-office and some remote work.
Required knowledge includes healthcare terminology, Medicaid provider qualifications, various Medicaid portals (WaMS, Kepro/Atrezzo/Acentra, Availity, MES), Virginia Medicaid MCO credentialing processes, service authorizations, insurance verifications, and office administration tools.
Skills needed are database proficiency, independent and collaborative work ability, strong communication, critical thinking, time management, and professionalism, including handling confidential information.
Minimum requirements: High school diploma or GED with experience in medical billing and Medicaid regulations; preference for education or equivalent experience in Healthcare Administration, Human Services, or Medicaid service authorization and credentialing.
Work environment is primarily office-based with some field work and variable daily work hours. Position requires some travel (~10%). Background and drug testing required.
DePaul Community Resources is an equal opportunity employer offering flexible work-from-home options.
- High school diploma or GED
- Experience working with medical billing and Medicaid regulations
- Preferred: Education in Healthcare Administration, Human Services, or equivalent work experience in Medicaid service authorization and credentialing
- Knowledge of Medicaid provider qualifications and portals, and credentialing processes
- Proficiency in database systems and office software
- Strong communication, organizational, and critical thinking skills
- Ability to work independently and collaboratively
- Completion of motor vehicle record, criminal, and child protective services background checks, and drug testing
- Flexible work from home options
- Employment with a nonprofit social impact organization
- Collaborative and inclusive workplace culture
- Opportunities to contribute to community support programs
Location
Virginia, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 week ago