Medicaid Prior Authorization Coordinator Job at Robert Half (Minnetonka)

Medicaid Prior Authorization Coordinator

This is a contract opportunity in the healthcare industry, where you will play a...

Location

United States , Hopkins, MN

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Bachelor’s degree in a related field preferred
Experience working with Medicaid billing processes
Strong technical skills, including proficiency with computers and Microsoft Excel
familiarity with Eldermark and PointClickCare is an asset
Understanding of insurance claims and billing practices
Exceptional attention to detail and commitment to maintaining high accuracy
Capable of working independently as well as collaboratively within a team

Job Responsibility

Organize and maintain documentation and digital records for Medicaid service authorizations and billing rates
Make real-time updates to the billing system when resident information, authorization details, or fee structures change
Monitor expiring authorizations and initiate the renewal process to guarantee uninterrupted claims processing and reimbursement
Track and record relevant Medicaid data, including resident rosters, authorization periods, billable services, and financial obligations
Enter and reconcile incoming Medicaid payments within the billing platform
Prepare and process patient billing statements for required contributions under Medicaid guidelines
Communicate with Medicaid provider representatives to resolve billing issues, clarify authorization requirements, and obtain necessary documentation

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Insurance Authorization Coordinator

We are looking for a detail-oriented and organized Insurance Authorization Coord...

Location

United States , Minneapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

1–3 years of experience in prior authorization, medical billing, insurance verification, or similar healthcare roles
Comprehensive knowledge of commercial insurance, Medicaid, Medicare, and payer-specific processes
Proficiency in healthcare systems such as Epic, Cerner, or Athena, along with experience using payer portals
Strong communication skills and exceptional customer service abilities
High level of attention to detail and excellent organizational skills
Ability to analyze clinical documentation and understand medical terminology
Experience with high-volume data entry and administrative tasks
Familiarity with insurance verification processes and scheduling operations

Job Responsibility

Review provider orders, clinical records, and insurance guidelines to assess prior authorization requirements
Monitor pending authorizations and follow up to secure timely approvals
Communicate effectively with providers, clinical staff, patients, and insurance representatives to provide updates or request additional documentation
Accurately record all actions, communication, and outcomes related to authorizations within internal systems
Confirm patient insurance coverage and validate benefit eligibility
Identify and report authorization issues or payer-specific trends to management
Assist with appeals and reconsideration processes for denied authorizations
Stay informed about payer regulations, medical necessity standards, and insurance protocols
Collaborate with billing and revenue cycle teams to ensure accurate authorization data is included with claims

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Care Coordinator

Our client is seeking a detail-oriented, service-driven Care Coordinator to supp...

Location

United States , Spring, TX

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Prior experience in DME, medical billing, utilization management, or care coordination preferred
Familiarity with Medicaid processes and insurance authorization workflows
Brightree software experience is a plus
Strong attention to detail and documentation accuracy
Excellent verbal and written communication skills
Comfortable handling frequent and sometimes emotionally intense phone conversations
Ability to manage multiple priorities in a fast-paced healthcare environment

Job Responsibility

Coordinate care services for pediatric patients and foster families
Communicate regularly with patient families, physicians, and community partners
Submit patient requests to physicians and follow up on required documentation
Secure eligibility information and request prior authorizations from insurance providers
Support medical billing and coding activities as needed
Maintain strict compliance with Medicaid and HIPAA regulations
Collaborate with referring agencies and healthcare providers
Coordinate durable medical equipment (DME) services
Deliver timely, accurate service while maintaining professionalism in high-stress situations

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Senior Field Reimbursement Specialist

Under general supervision of a Senior Manager, the Sr Field Reimbursement Specia...

Location

United States , Remote

Salary:

100700.00 - 155100.00 USD / Year

Cencora

Expiration Date

Until further notice

Requirements

Experience related and progressively responsible in a medical practice, private or third-party reimbursement arena, or pharmaceutical industry in sales, managed care, or clinical support
Experience within healthcare provider support such as a physician practice, patient assistance program or similar pharmaceutical/biological support program experience preferred
Bachelor’s degree preferred
Minimum of 7 years of experience
Candidates must possess a Prior Authorization Certification Specialist (PACS) credentials from an industry approved licensing body, or obtain certification within the first six months of employment
Ability to effectively manage multiple client relationships and customer
Ability to manage and support external meetings, presentations, and client interactions
Ability to lead and work in a matrix environment
Proven teamwork and collaboration skills with a demonstrated record of accomplishment of working in highly matrixed and cross-functional organizations
Ability to manage multiple tasks, timelines, expenses, and other activities necessary to fulfill the roles and responsibilities of a Field Reimbursement Specialists

Job Responsibility

Plan and engage with customers, leveraging client approved resources, to educate on access and reimbursement topics relevant to assigned client’s product
Track progress and evaluate results of assigned activities
Recommends changes in procedures
Lead or direct more complex projects or certain aspects of projects
Operates with reasonable latitude for un-reviewed action or decision
Work within a matrix environment to collaborate with internal and external stakeholders to secure optimized patient access and provide appropriate education through a focused effort on healthcare providers in community, institutional, and academic medical settings
Manage daily activities that support appropriate patient access to our client’s products in the provider offices and healthcare institutions, working as a liaison to other patient assistance and reimbursement support services offered by our clients
Review patient insurance benefit options with appropriate authorizations
Validate prior authorization requirements
Understanding of Specialty Pharmacy processes

What we offer

medical
dental
vision care
comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness
support for working families
backup dependent care
adoption assistance
infertility coverage
family building support
behavioral health solutions

Fulltime

New

Medical Customer Service Rep

We are looking for a Medical Customer Service Rep to support a healthcare organi...

Location

United States , Minneapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Previous experience in a call center or customer service environment, preferably within healthcare or health insurance
Working knowledge of Medicaid, including eligibility, claims, managed care, and related member services
Familiarity with prior authorizations and the ability to explain healthcare processes clearly to members
Strong verbal communication skills with the ability to remain attentive to detail and empathetic during frequent member interactions
Ability to manage a high volume of calls while maintaining accuracy, attention to detail, and quality service
Comfortable using multiple systems and resources to research member information and resolve questions efficiently
Proven ability to document information thoroughly and follow established procedures for issue resolution

Job Responsibility

Handle incoming calls from health plan members and provide clear answers related to coverage, claims activity, and amounts owed to providers
Review member benefit information and explain plan details in a way that is easy to understand and aligned with service standards
Assist callers with questions involving Medicaid programs, managed care services, and eligibility-related concerns
Help members understand prior authorization requirements and direct them through the appropriate next steps for care access
Use provider network resources to confirm participating providers and support members in locating appropriate care options
Guide members through transportation service coordination and appointment navigation when those services are part of their health plan benefits
Document interactions accurately and maintain complete records of inquiries, resolutions, and follow-up needs
Escalate complex issues when necessary while ensuring members receive timely and courteous support

What we offer

medical insurance
vision insurance
dental insurance
life insurance
disability insurance
401(k) plan

Fulltime

Authorization Coordinator

Join a dedicated healthcare provider supporting patients in the Springfield area...

Location

United States , Springfield

Salary:

44000.00 - 54000.00 USD / Year ▼

Goodwin Recruiting

Expiration Date

Until further notice

Requirements

High School Diploma or equivalent required
Minimum 1 year of hands-on prior authorization experience
Working knowledge of payer rules for commercial insurance, Medicare, Medicare Advantage, and Medicaid
Excellent attention to detail and ability to manage multiple priorities
Strong communication and customer service skills
Reliable, organized, and comfortable working fully onsite

Job Responsibility

Submit prior authorizations, referrals, and precertifications for radiation oncology services
Track authorization status, follow up, and secure approvals within required timeframes
Manage denied authorizations and lead the appeals process to resolution
Communicate authorization issues and requirements to physicians, clinical, and billing teams
Review payer guidelines to ensure medical necessity and compliance
Maintain accurate documentation across clinical and authorization systems
Build relationships with insurance payers to improve approval outcomes
Participate in team meetings and contribute to ongoing process improvements

What we offer

Comprehensive benefits package including medical, dental, and vision insurance
Generous paid time off: two weeks PTO and two weeks paid sick time
Discretionary annual bonus opportunities based on company performance
Unique employee perk: access to a company-owned rental property after one year of employment
Employee Stock Ownership Plan (ESOP): Company is 100% employee-owned
Annual share allocations based on salary, fully vested after three years
Shares can be cashed out at retirement, offering long-term wealth-building

Fulltime

Behavioral Health Medical Director

The Behavioral Health Medical Administrator (Medical Director) directs, leads, a...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

3 years of experience in a clinical setting
1 year of experience in physician leadership role, including quality review, utilization review, population health and other managed care functions
Medical Degree
Active, current, and unrestricted license to practice medicine in the State of Arizona (a state in the United States)
Board Certification in general psychiatry, or adult and child/adolescent psychiatry, through the American Board of Psychiatry and Neurology
Requires knowledge and skills in state (Arizona) and federal behavioral health regulations, requirements for publicly funded services, delivery, operations, and licensure.
Knowledge of managed care concepts and practices
and emerging and best practices for adult & children’s integrated care programs.
Ability to use electronic word processing, email, and electronic database resources.
Excellent customer service and oral/written communication skills

Job Responsibility

Directs, leads, and provides professional oversight for medical management and population health activities related to behavioral health utilization management, case and care management, disease management, performance improvement, and quality management activities.
Supports collaborative relationships with physicians and hospitals to achieve mutually acceptable business goals in compliance with AHCCCS and CMS regulations.
Provides physician leadership and medical oversight in the design, implementation and review of clinical services, best practices, care management, medical management and quality management.
Serves as liaison between the Medicaid Business Segment and medical and behavioral health practitioners at stakeholder and provider agencies.
Participates in aggregate and member-level clinical analyses for quality management, quality of care concerns, peer review, medical management, and utilization review processes.
Reviews and authorizes requests by providers and treatment coordinators for services or programs requiring prior authorization.
Participates in the design and implementation of best practices, clinical standards, protocols, and treatment guidelines.
Participates in credentialing, re-credentialing and competency processes for providers.
Assists care managers with care management of high risk/high-cost members.
Participates as a member or chair of internal and external committees.

Parttime

Direct Support Manager

Ensures the delivery of direct care services to Community and Employment Service...

Location

United States , Little Rock

Salary:

Not provided

Easterseals Arkansas

Expiration Date

Until further notice

Requirements

Bachelor's degree (B. A.) preferred from a four-year college or university in Psychology, Social Work, Special Education or related field
Minimum of 2 years equivalent experience working with individuals with developmental disabilities in a HCBS or DD setting
Valid Arkansas Driver's License
High School Diploma
Ability to work collaboratively and effectively with individuals served, families, and staff
Competence in instructional, oral, and written communication
Competence in organizational leadership and supervisory skills
Strong interpersonal skills
Ability to work with a variety of individuals regarding age, education, functionality, and with minimal direction
Ability to present information and train staff

Job Responsibility

Supervises multiple Direct Support Professionals (DSPs) who provide direct care to individuals served in the statewide CES Waiver program
Manages service delivery by DSPs to all individuals assigned to caseload
Remains on-call for any after-hours emergency needs or crisis intervention
Maintains an accurate and thorough knowledge of current CES Waiver services, licensing regulations and ESA policies and procedures
Coordinates staffing schedules for CES Waiver supports, other Medicaid services, and additional services and supports
Calculates costs of all direct care services for each individual CES Waiver treatment plan
Submits prior authorization request for CES Waiver services to PASSE for approval
Coordinates the development of the annual and comprehensive Individual Treatment Plan (ITP)
Coordinates and facilitates annual client specific training for all assigned DSPs
Reviews daily service records submitted by DSP for each individual served

Fulltime

Medicaid Prior Authorization Coordinator

Robert Half

Location:
United States , Minnetonka

Category:
-

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
March 01, 2026

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