Top 17 Insurance denial specialist Jobs in Columbus

Utilization Management Specialist
ST VINCENT FAMILY SERVICES —Columbus, OH
- Weekends as needed
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Paid time off
- 401(k) matching
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BH Insurance/Precert Specialist
Nationwide Children's Hospital —Columbus, OH
- Full-time
- CPR Certification
- BLS Certification
- High school diploma or GED
Procedure Denial & Authorization Follow‑Up Specialist
Pain Zero LLC —Grove City, OH
- $18.50 - $20.00 an hour
- Full-time
- Background check
- Clinic experience
- In-person
- Paid time off
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Fraud and Abuse Investigator / CPC - Remote
Sentara Workforce Solutions, LLC —Columbus, OH
- $25.60 - $42.67 an hour
- Overtime
- Remote
- Mid-level
- Bachelor's degree
- 2 years
- 403(b) matching
- Paid parental leave
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1d
Revenue Cycle Representative
Ohio State University Physicians —Columbus, OH
- $18.20 - $27.29 an hour
- Full-time
- Hybrid work
- Writing skills
- Research
- Mid-level
- Wellness program
- Paid holidays
11h
Documentation and Reimbursement Specialist
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Hybrid work
- Computer literacy
- Writing skills
- Research
Medical AR Billing Specialist
Ohio Foot and Ankle Specialists LLC —Lewis Center, OH
- Full-time
- Computer literacy
- HIPAA
- Research
- Paid holidays
- Health insurance
Senior Revenue Recovery Specialist
Ensemble RCM LLC —Columbus, OH
- $22.45 - $24.70 an hour
- Full-time
- Customer service
- 5 years
- Office
- Tuition reimbursement
11d
Payment Specialist
Orthopedic One —Westerville, OH
- Full-time
- Hybrid work
- Computer literacy
- Basic math
- Windows
Medical AR Billing Specialist
Gentle Footcare LLC —Columbus, OH
- Full-time
- Computer literacy
- HIPAA
- Research
- Paid holidays
- Health insurance
Clinical Finance Case Management Specialist 2
The Ohio State University Wexner Medical Center —Columbus, OH
- Online Application
- Hybrid work
- Background check
- Nursing
- Pass drug screening
Medical Billing Specialist
Central Ohio Urology Group —Columbus, OH
- $17 - $23 an hour
- Full-time
- Hybrid work
- Background check
- Mid-level
- Microsoft Office
- Health savings account
- Health insurance
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Inpatient Coding Auditor
Huron Managed Services LLC —Columbus, OH
- $38.46 - $52.40 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Dental insurance
Quick Apply
9d
Senior General Liability Litigation Specialist
TheBest Claims Solutions —United States
- $85,000 - $110,000 a year
- Remote
- Senior level
- 2 years
- Commercial

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The Ohio State University Wexner Medical Center —Columbus, OH
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Utilization Management Specialist
ST VINCENT FAMILY SERVICES —Columbus, OH
Associate's Degree required; Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work, Public Health, or related field.
Quick Apply
BH Insurance/Precert Specialist
Nationwide Children's Hospital —Columbus, OH
CPR certification (based on position and as determined by manager). Contacts insurance companies to obtain and verify benefit information, documents all benefit…

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insurance denial specialist jobs near columbus

Utilization Management Specialist

ST VINCENT FAMILY SERVICES
Columbus, OH

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Job Details

Full-time

Benefits

Paid time off
401(k) matching

Qualifications

Associate's degree

Full Job Description

At St. Vincent Family Services, it's our job to help families build bright futures. Make it your job, too!

We offer competitive compensation based on education, experience, licensure, and internal equity, along with comprehensive benefits, 401(k) matching, and a generous PTO package.

These are just a few of the many reasons to join our team.

SUMMARY

The Utilization Management Specialist is responsible for coordinating and managing all prior authorization activities for clinical services across multiple Medicaid Managed Care Organizations (MCOs). This position serves as the primary liaison between St. Vincent Family Services and MCO payors to ensure authorization requests are submitted timely, approved services are tracked accurately, and service disruptions are prevented.

The Utilization Management Specialist monitors client eligibility, tracks authorized units by procedure code, manages authorization renewals, and communicates authorization approvals and denials to treatment teams. This role works closely with clinical staff, program leadership, billing, and MCO representatives to maximize reimbursement, ensure compliance with payer requirements, and support continuity of care for clients.

ESSENTIAL DUTIES & RESPONSIBILITIES

Maintains confidentiality and compliance with HIPAA, agency policies, and payer regulations.
Serves as the primary point of contact for all MCO prior authorization activities.
Monitors and reviews MCO portals to track authorization status, pending requests, approvals, denials, and requests for additional information.
Verifies and documents client eligibility and insurance coverage prior to authorization submission and throughout treatment episodes.
Runs authorization utilization reports and analyzes data to identify clients approaching authorization thresholds.
Maintains an authorization tracking system that includes:
- Authorization numbers
- Approved dates of service
- Procedure codes
- Authorized units
- Units utilized
- Remaining units
- Expiration dates
Monitors service utilization and proactively identify clients nearing authorized unit limits.
Requests completed clinical documentation and authorization forms from treatment providers when renewal thresholds are met.
Reviews authorization packets for completeness and accuracy prior to MCO submission.
Submits initial, concurrent, and reauthorization requests to Medicaid Managed Care Organizations within required timelines.
Coordinates responses to MCO requests for additional documentation or clinical information.
Communicates authorization approvals, denials, partial approvals, and service changes to treatment team members in a timely manner.
Collaborates with program directors, treatment providers, and billing staff to resolve authorization concerns and prevent service interruptions.
Maintains organized electronic records of all authorization submissions, determinations, and correspondence.
Tracks authorization denial patterns and communicates trends to leadership.
Assists with audits, quality assurance activities, and compliance reviews related to authorization management.
Develops and maintains productive working relationships with MCO representatives.
Participates in department meetings, training, and process improvement initiatives.
Performs other duties as assigned.

QUALIFICATIONS

Education and/or Experience:

Associate's Degree required; Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work, Public Health, or related field.
Minimum of two years of experience in healthcare authorization management, utilization management, medical billing, behavioral health administration, or related healthcare setting preferred.

Knowledge, Skills & Abilities:

Strong understanding of behavioral health authorization processes and payer requirements.
Knowledge of Medicaid and Managed Care authorization procedures preferred.
Excellent organizational skills and attention to detail.
Strong analytical skills and ability to interpret utilization and authorization reports.
Ability to manage multiple deadlines and competing priorities.
Ability to communicate effectively with clinical, administrative, and payer representatives.
Ability to maintain accurate records and follow complex payer requirements.
Ability to work independently while functioning as part of a collaborative team.

Technical Skills

Proficiency in Microsoft Outlook, Excel, Word, and Teams.
Ability to learn and navigate multiple MCO portals.
Experience with electronic health records and data management systems.
Ability to generate, analyze, and maintain utilization tracking reports.

WORK ENVIRONMENT

Standard office environment with occasional evenings/weekends for events. Hybrid schedule available after 90-day probationary period.

Requires prolonged sitting and extensive computer use.
Requires manual dexterity sufficient to operate a computer, telephone, and other office equipment.
Requires normal range of hearing and vision to prepare reports and communicate effectively.
May occasionally lift and/or move items up to 15 pounds.

Quick Apply

Refine Your Search

insurance denial specialist jobs in columbus

Utilization Management Specialist

BH Insurance/Precert Specialist

Procedure Denial & Authorization Follow‑Up Specialist

Fraud and Abuse Investigator / CPC - Remote

Revenue Cycle Representative

Documentation and Reimbursement Specialist

Medical AR Billing Specialist

Senior Revenue Recovery Specialist

Payment Specialist

Medical AR Billing Specialist

Clinical Finance Case Management Specialist 2

Medical Billing Specialist

Inpatient Coding Auditor

Senior General Liability Litigation Specialist

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