About this role
Investigate and resolve payer and agency denials.
• Review denial reasons and coordinate corrective actions with clinical and billing staff.
• Submit initial, concurrent, and retrospective authorization requests as required.
• Monitor authorization expirations and obtain extensions before services lapse.
• Track denied claims and authorizations through resolution.
• Communicate authorization requirements and deficiencies to clinical staff.
• Work directly with Medicaid managed care organizations and commercial insurance plans regarding authorization issues.
• Prepare and submit reconsiderations and appeals when appropriate.
• Maintain accurate documentation of all payer communications and authorization activity.
• Identify denial trends and recommend process improvements to reduce future denials.
• Assist with audits related to authorizations and payer compliance.
• Maintain knowledge of payer guidelines, Ohio Medicaid requirements, and agency regulations.
• Collaborate with the billing department to ensure timely claim submission and reimbursement.
• Perform other related duties as assigned.
Qualifications/ Education/Experience Requirements:
• High school diploma or GED required; associate degree preferred.
• One to three years of experience in medical billing, prior authorizations, insurance verification, or behavioral health preferred.
• Experience with Medicaid managed care organizations and behavioral health billing is strongly preferred.
• Knowledge of medical terminology, payer authorization processes, and insurance denials.
• Strong organizational and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities while meeting deadlines.
• Proficiency with electronic health records and Microsoft Office applications.
Performance Expectations
• Maintain timely submission and follow-up of all authorization requests.
• Minimize preventable authorization-related denials.
• Meet departmental productivity and accuracy standards.
• Maintain complete and accurate documentation.
• Demonstrate professionalism, accountability, and effective communication.
• Support continuous improvement initiatives that reduce denials and improve reimbursement $18-$22/hourly