Authorization Processing Specialist

Authorization Processing Specialist - Full-Time - Day Shift

Community Care is hiring an Authorization Processing Specialist. This rewarding opportunity is perfect for someone who enjoys team collaboration, being part of a mission driven organization and who shares our mission to help elderly individuals and adults with physical and intellectual disabilities continue to live as independently as possible in the community. This is a full-time hybrid opportunity at our Waukesha Office.

Authorization Processing Specialist Job Responsibilities: 

Responsible for processing and adjudicating submitted authorizations received from IDT staff according to provider contract, Medicare/Medicaid guidelines, and ensuring a high level of customer service and maximizing productivity by processing authorizations correctly.

• Provides first line service authorization support for Community Care's care management staff and external providers.
• Reviews each submitted authorization to ensure it is accurate to complete, is a covered service, contains adequate HCPC or CPT codes based on provider contract and/or Medicare/Medicaid guidelines.
• Ensures timely and accurate responses to inquiries and authorization request.
• Resolves authorization problems, applying good customer service in a timely manner.
• Identify issues and discuss them with care team or management.
• Assistance in determining products, codes and providers.
• Support may be delivered face to face, by telephone, or via email and may include manual entry of authorization requests into Authorization Referral Program, technical support using the electronic authorization process.

Authorization Processing Specialist Job Requirements:

• Experience: 2 years of experience in a call center or help desk support role in a health care or insurance environment required.
                       2 years of experience in a support role in health care or insurance environment required.                     
                       HCPC and/or CPT coding experience and experience working with Medicare/Medicaid preferred.
• Education: High School Diploma required
                      Related college work and formal training in spreadsheet and word processing applications preferred.

Authorization Processing Specialist Job Schedule:

• Monday - Friday 8:00AM - 4:30PM

About Community Care

Community Care is a local nonprofit with more than 40 years of experience helping older adults and adults with disabilities live as independently as possible within the community. We coordinate and deliver a full range of supportive services that help more than 13,000 Wisconsin residents live safely, confidently, and with dignity. We are Wisconsin-based with local offices supporting each of the 15 counties we serve. Our dedicated team works with members to develop care plans to meet their health and social needs Together with our community partners, we’re committed to providing compassionate, personalized care that empowers members to live a healthy and independent lifestyle.

Compensation and Benefits: 

Our employees make a real difference in people’s lives every day, that is why we are proud to offer a compensation package that includes:
•    Generous, paid time off
•    Competitive pay and benefits (health, dental, vision, etc.) 
•    Flexible benefits plan
•    Employee referral program
•    Coworkers care program
•    Retirement plan with employer contribution
•    Employee Assistance Program

Community Care is an Equal Opportunity Employer