Medical Insurance Authorization and Billing Specialist

Oversee authorization and documentation workflows for CalAIM Enhanced Care Management (ECM) and Community Supports (CS) services. This role supports timely submission of required documentation to managed care plans, helps coordinate intake and eligibility processes, and ensures services are approved and billed in alignment with contractual and regulatory requirements.

Key responsibilities include:

• Manage member service authorizations and reauthorizations for active ECM and CS participants
• Prepare and submit required forms and reports to managed care plans
• Track authorization denials, claims, billing issues, appeals, and grievances
• Maintain accurate documentation in EMR and related systems
• Support eligibility verification, intake coordination, and referral workflows
• Monitor authorization expirations and billing alignment to prevent service disruptions
• Assist leadership with audits, reporting, and workflow improvements
• Train staff and help refine processes as the program grows
• Provide administrative and operational support as needed during the growth phase