Agency: A Senior Connection
Job Title: Medical Insurance Authorization and Billing Specialist
Reports to: Program Supervisor or Program Director
Works in Collaboration With: CEO, Program Director, Program Supervisor, Lead Care Managers, Navigators, Intake staff, Billing & Ops Assistant
Location: This is hybrid position. You will be required to have a HIPAA complaint at home office and meet (at minimum quarterly) in Sacramento and surrounding counties. While the position is hybrid, you must be located in Northern California. Those who do not reside in the surrounding areas will not be considered.
*This position requires experience in medical authorizations and billing. Additionally, priority will also go to applicants with experience in claims and denials. If you do not have experience in both medical (health insurance) authorizations and billing, please do not apply.
Position Summary
The Medical Insurance Authorization and Billing Specialist oversees all authorization and documentation workflows related to CalAIM Enhanced Care Management (ECM) and Community Supports (CS) services. This role is responsible for ensuring timely submission of all required documentation to managed care plans (MCPs), supporting intake, eligibility processes, and service-type determinations, and maintaining compliance with all regulatory and contractual documentation standards. The Medical Insurance Authorization and Billing Specialist also assists with and/or oversees all MCP-required reporting including client status lists and provider capacity reports. The Medical Insurance Authorization and Billing Specialist plays a critical role in ensuring that services are approved and delivered in alignment with contractual expectations and billing requirements.
Essential Job Duties and Responsibilities: Authorizations & Submissions
- Manage all member service authorizations and billing (initial and reauthorizations) for active ECM and CS participants
- Prepare and submit required forms to MCPs (e.g., MIFs, Capacity Reports, OTF/RTF, close loop referrals)
- Ensure timeliness and accuracy of authorizations and billing to avoid service or payment delays
- Maintain up-to-date knowledge of authorization and billing protocols across different MCPs
- Flag and track authorization denials, claims, billing, preparing and submitting necessary appeals and grievances and monitoring and escalating trends to leadership
Documentation Oversight
- Track all submitted documentation and ensure proper filing within EMR and relevant systems
- Keep collections reports updated with status changes and new authorizations
- Conduct internal checks for completeness of documentation (e.g., assessments, consent forms)
- Collaborate with billing and leadership to align authorization and documentation processes
- Flag and escalate any eligibility or documentation gaps that may impact services
Eligibility & Intake Support
- Participate in or support real-time eligibility verification for new referrals and members
- Coordinate with intake staff to ensure proper documentation is received and processed for new members
- Work directly with referral partners, clients, or responsible parties during the eligibility and authorization process, communicating statuses and requesting necessary documentation or forms as required
- Provide timely warm-hand-offs to LCM once member is authorized and notify all required team members (Program Supervisor or Director, Claims, etc.)
Program Compliance
- Stay current on CalAIM ECM/CS documentation requirements and MCP updates, helping to communicate updates to the rest of the staff.
- Support leadership in preparing for audits or reporting by ensuring clean, complete records
- Closely monitor authorizations and expiration dates to ensure ongoing service continuity
- Cross-reference billing tracker to help ensure service encounters align with approved services
- Work directly with MCP to manage authorization barriers, communicate regarding MCP-required reporting, and respond to client service questions
- Develop or improve upon workflows and train staff to ensure they are aligned with items that impact authorization and MCP requirements
General Expectations
- Demonstrate accuracy, timeliness, and organization in documentation workflows
- Be proactive in identifying documentation issues or inefficiencies and suggesting improvements
- Manage time effectively, prioritize competing demands, and meet multiple deadlines with accuracy
- Communicate clearly and professionally with care teams, MCPs, and leadership around documentation needs
- Protect member privacy and comply with HIPAA at all times
- Use internal tracking tools consistently and keep documentation systems updated
- Collaborate respectfully across all departments and regions
- Demonstrate initiative and flexibility when navigating changes in MCP or CalAIM protocols, and the ability to work independently with minimal supervision
- Participate in staff meetings and trainings as assigned
- Represent ASC professionally and in alignment with its mission and values
Qualifications
- Associate degree; bachelor’s preferred - or equivalent work experience
- Required minimum 2 years of experience in health care authorizations and billing with priority to those who have experience working with claims/denials
- Proficiency with CalAIM, ECM, and MCP reporting, documenting, and authorization workflows highly preferred
- Experience with EMRs and document management systems
- Strong attention to detail and high level of accuracy
- Knowledge of Kaiser, Anthem, Health Net, Partnership, Molina, and/or Healthplan of San Joaquin highly preferred
- Proficiency in Google Workspace, SalesForce, or equivalent platforms
Work Setting
- 80% remote / home-office based
- 20% in-person for client in person outreach attempts, team collaboration, training, and file review as needed
- This is a hybrid position
Position Growth & Flexible Support Responsibilities
This is a growing position. At the time of hire, the Medical Insurance Authorization and Billing Specialist role may not yet be full-time based solely on authorization-related duties, as authorization volume will continue to expand alongside program growth, service expansion, and additional MCP contracts. During this initial growth phase, the Medical Insurance Authorization Specialist may be asked to support additional operational or administrative tasks that reasonably align with this role and do not require extensive additional training. These duties are intended to complement authorization, documentation, and program support workflows and may include, but are not limited to:
- Administrative support for ordering program or office supplies through approved online platforms
- Light intake, referral coordination, or documentation support
- Data tracking, reporting, or spreadsheet maintenance
- Documentation cleanup or quality assurance reviews
- Cross-team administrative support services
- Optional support with accounts receivable–related tasks (for individuals with prior A/R or billing experience; not required)
- Process improvement or workflow documentation projects
As authorization volume increases, the role is expected to evolve into a more fully dedicated authorization-focused position. ASC is committed to regularly evaluating workload, scope, and capacity to ensure responsibilities remain appropriate, sustainable, and aligned with program and funding needs. Flexibility, initiative, and a collaborative mindset are essential during this growth phase. This role offers the opportunity to contribute to operational support while helping build and refine authorization workflows as the program scales.
*Please answer the pre-screen questions to be considered for this role.
Job Type: Full-time
Pay: $55,000.00 - $80,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Health insurance
- Paid time off
Application Question(s):
- Briefly describe your hands-on medical insurance authorization experience, including how many years you’ve performed prior authorizations and the types of services you handled.
- Which California Medi-Cal Managed Care Plans (MCP) have you worked with directly when submitting authorizations?
- What specific experience do you have with medical insurance authorization or prior authorization workflows?
- Which insurance verification or authorization systems/portals (payer portals/EHR) are you comfortable with?
Work Location: Hybrid remote in Sacramento County, CA
