Position Summary:

The Authorization Specialist is responsible for obtaining, tracking, and managing service authorizations from Minnesota DHS and managed care organizations to ensure clients receive timely, uninterrupted services. This role reviews client eligibility, submits authorization requests, monitors approval timelines, and proactively follows up to resolve delays or discrepancies.

The Authorization Specialist serves as a central liaison between internal teams, state systems, and payer representatives to ensure all documentation is accurate, compliant, and submitted within required timeframes. They maintain detailed records, escalate issues as needed, and ensure renewals are processed before expiration to prevent service disruption.

Success in this role requires strong organizational skills, attention to detail, the ability to work with high-volume caseloads, and consistent follow-through. The ideal candidate is proactive, organized, excellent at prioritization of work, deadline-driven, and comfortable navigating payer portals, state systems, and authorization workflows.

Main Duties:

Required to support uninterrupted client services, ensuring regulatory compliance, and protecting organizational revenue.

Authorization Management

• Submit initial, on-going adjusted and renewal authorization requests to state agencies and MCOs.
• Monitor authorization status and follow up frequently to ensure timely receipt and uninterrupted service for clients. 
• Track expiration dates and ensure renewals are submitted in advance to prevent service gaps.
• Timely and accurately respond to any external requests for additional information, corrections, or clarifications.
• Research and resolve all issues related to missing, incorrect, or denied authorizations.
  

Eligibility & Compliance

• Verify client eligibility, plan type, and benefits coverage through state systems, MCO portals, or eligibility tools.
• Ensure service authorizations align with regulatory requirements, plan limits, and clinical guidelines.
• Maintain compliance with payer documentation standards, HIPAA privacy requirements, and state rules.

Communication & Coordination

• Serve as the primary point of contact with state agencies, MCOs, and payer representatives regarding authorization requirements.
• Partner with advisors, billing staff, and supervisors to ensure accurate information is submitted.
• Notify staff promptly of approved, pending, or denied authorizations and required next steps.
• Communicate and educate staff about changes in payer policies, authorization criteria, or required documentation.

Documentation & Recordkeeping

• Maintain accurate and timely records of all authorization requests, approvals, denials, and renewals.
• Update internal systems with authorization numbers, service dates, units/hours approved, and expiration dates.
• Upload or attach authorization documents to client records as required.

Denial Prevention & Resolution

• Proactively identify and resolve authorization gaps that could lead to claim denials or service delays.
• Assist with denials management by providing authorization documentation and collaborating with billing teams.
• All other duties as assigned.

Position Requirements:

• High school diploma or equivalent (associate degree preferred). 
• 1–3 years of experience in healthcare authorization, medical office administration, billing, case management, or payer coordination. 
• Experience using state authorization systems, payer portals, or managed care platforms. 
• Strong attention to detail and accuracy with documentation. 
• Excellent follow-through and ability to manage multiple tasks and deadlines. 
• Strong communication skills and professional phone/email etiquette. 
• Ability to work independently and collaborate with multidisciplinary teams.
• Experience with Medicaid, managed care plans, waivers, or state-funded programs. 
• Familiarity with clinical documentation, service codes, and prior authorization regulations. 
• Knowledge of HIPAA, healthcare privacy requirements, and payer authorization rules preferred
• Experience in high-volume or fast-paced documentation and authorization environments.
• Must pass a background study with the Minnesota Department of Human Services.
• All employees working remotely will be required to adhere to company remote work policies

Competency’s Needed:  

• Action Oriented: Works hard, is action oriented and full of energy for challenges; not fearful of acting with a minimum of planning to seize opportunities.
• Drive for Results: can be counted on to exceed goals successfully; is bottom-line oriented, steadfastly pushes self and others for results.
• Integrity and Trust: is widely trusted, seen as direct, truthful and can present the truth in an appropriate and helpful manner, keeps confidences, admits mistakes, does not misrepresent self for personal gain.
• Follow-Through: Persistent and proactive in monitoring authorization status. 
• Detail Orientation: Accurate data entry, documentation, and record keeping. 
• Communication: Clear, professional interaction with payers and internal teams. 
• Problem-Solving: Investigates denials, delays, and discrepancies effectively. 
• Time Management: Meets tight deadlines and handles large caseloads. 
• Accountability: Owns the process from submission through approval. 
• Confidentiality: Handles sensitive information with professionalism.

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.  
• See complete Job Analysis for details.