Medicaid Prior Authorization Coordinator Job at Robert Half (Hopkins, MN)

Medicaid Prior Authorization Coordinator

We are looking for a dedicated Medicaid Prior Authorization Coordinator to join ...

Location

United States , Minnetonka

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

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

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

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

Field Reimbursement Manager

Join Amgen’s Mission of Serving Patients. At Amgen, if you feel like you’re part...

Location

United States , Houston

Salary:

155968.00 - 173578.00 USD / Year

Amgen

Expiration Date

Until further notice

Requirements

Doctorate degree AND 2 years of experience in the public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales
Master’s degree AND 6 years of experience in the public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales
Bachelor’s degree AND 8 years of experience in the public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales
Associate degree AND 10 years of experience in the public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales
Bachelor's degree in business, healthcare, or a related field
6 years' experience with specialty/biologic self-injectable (pharmacy benefit) or physician-administered (buy and bill/medical benefit) products
Advanced knowledge of medical insurance terminology
Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part B – for buy & bill products and Part D for Pharmacy products)
Ability to manage ambiguity and problem-solve
Ability to manage expenses within allocated budgets

Job Responsibility

Manage defined accounts within a specified geographic region for Patient Access and Reimbursement
Support products by executing the collaborative territory strategic plan
Ensure an understanding of the reimbursement process, field reimbursement services, and patient support programs
Work on patient-level reimbursement issue resolution, requiring knowledge and experience with patient health information (PHI)
Act as an extension of the HUB, providing live one-on-one coverage support
Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements and forms
Review patient-specific information in cases where the site has specifically requested assistance resolving any issues or coverage challenges
Educate and update healthcare providers (HCPs) on key private and public payer coverage and changes that impact patient product access
Coordinate access/reimbursement issues with relevant partners, including the HUB
Provide information to HCPs on how the products are covered under the benefit design (Commercial, Medicare, Medicaid)

What we offer

A comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts
A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan
Stock-based long-term incentives
Award-winning time-off plans
Flexible work models, including remote and hybrid work arrangements, where possible

Fulltime

Manager Reimbursement - Accounting

The primary purpose of the Reimbursement Manager is to ensure proper payments ar...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Bachelor's Degree required

Job Responsibility

Prepare and review monthly contractual allowance journal entries and supporting calculations and responsible for proper balances in associated income statement and balance sheet accounts, for multiple facilities
Scope of accounting responsibility includes Medicare, Medicaid, USFHP, CHAMPUS, Blue Cross, Worker's Compensation and Managed Care
Analyze monthly contractual allowance variances, providing detailed explanations for significant fluctuations to Hospital Administration for use during close meetings
Maintain current, correct account analysis' related to program Income Statement and Balance Sheet accounts
Ensure monthly reports are prepared timely and accurately by supporting departmental Associates
Prepare final hospital and home office cost reports, completing comparative analysis of the cost report versus the financial statement and compliance checklist prior to submission, for multiple facilities
Ensure Medicare, Medicaid and CHAMPUS cost reports are submitted by due dates to prevent loss of reimbursement to the facilities
Identify and pursue proper reimbursement methodologies in an effort to receive all reimbursement due based upon Medicare, Medicaid and CHAMPUS Regulations
Coordinate the Medicare Field Audits, ensuring complete, proper and timely information is provided and audit adjustments are reviewed prior to issuance of the settlement
Errors found must be communicated in writing to the Auditors during the audit, to ensure proper settlement and issuance of the Notice of Program Reimbursement

Fulltime

Unit Manager

The Unit Manager is primarily responsible for overseeing day-to-day patient care...

Location

United States , Litchfield Park

Salary:

40.00 - 46.00 USD / Hour

Sun Health

Expiration Date

Until further notice

Requirements

Registered Nurse currently licensed by the State of Arizona OR equivalent combination of Licensed Practical Nurse with experience in managing a post-acute SNF unit
Management experience preferred
Must maintain negative tuberculosis at hire and annually during employment
Flu shot and relevant immunizations are required
Must have current CPR certification. CPR certification must remain current during employment. Clinical Other/BCLS - Basic Life Support Current BLS, PALS and or ACLS
Have a valid Level 1 Fingerprint Clearance Card or ability to obtain required
Excellent written and verbal communication and presentation skills required

Job Responsibility

Plans, develops, organizes, implements, and directs nursing services for residents on the unit assigned
Ensures compliance with current applicable federal, state, and local regulations and facility policies and procedures
Reviews complaints and grievances made or filed by staff. Makes appropriate reports to the Director of Nursing as required or as necessary
Performs regular audits to ensure clinical documentation needs regulations and facility policies
Collaborates with the Director of Nursing and Physicians to develop, implement, and adjust patient care plans and coordinate resident care
Create nursing/aide assignments
Assist with admissions as indicated
Assist in training nurses and other health professionals
Improve the quality and efficiency of the level of care delivered to patients
Recognize and assist in solving clinical and administrative problems

What we offer

Comprehensive health benefits (Medical, Dental & Vision)
401k with immediate vesting and up to 4% employer match
Tuition Reimbursement
Exclusive discounts through The Employee Network
Access to the Employee Association, supporting team members in need

Fulltime

Medicaid Prior Authorization Coordinator

Robert Half

Location:
United States , Hopkins, MN

Category:
-

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
March 13, 2026

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