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

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

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

New

Support Services Specialist

Summary: Supports all administrative components for the Outpatient Services prog...

Location

United States , Little Rock

Salary:

Not provided

Easterseals Arkansas

Expiration Date

Until further notice

Requirements

High School Diploma/GED and 3-5 years’ experience in providing administrative services in Early Intervention Day Treatment, Early Intervention, Pediatric Therapy or other Social Services program
A Bachelor's Degree in Social Services, Early Childhood Education or other Health Related Field preferred
Excellent written and verbal communication skills
Excellent interpersonal skills
Excellent organizational skills
Good time management skills
Ability to work effectively and collaboratively with individuals receiving services with diverse ability levels and employees with diverse experience and knowledge levels
Ability to be self-directed, creative and to take initiative
Demonstrated commitment to the values of diversity, equity, and inclusiveness
Competency with computer skills, i.e., Microsoft and Goggle applications including Word/Goggle Docs, Excel/Google Sheets and Gmail

Job Responsibility

Initial contact with referrals to determine service needs, answer questions and to begin intake process
Completes all necessary admission paperwork and processes for enrollment in services for assigned programs
Obtains initial and ongoing evaluation and treatment prescriptions to ensure prescriptions are current and align with treatment recommendations
Coordinates and schedules screenings and evaluations including Therapy (OT, PT, ST, ABA) and Developmental
Sends evaluation reports for disability determination, annual Medicaid certification, TEFRA determination, etc
Verifies Medicaid and other funding eligibility, as assigned and supports families in funding applications (i.e., Medicaid, Tefra, etc.) and redetermination processes
Communicates with parent/guardian regarding information or actions needed related to obtaining prescriptions, funding, PCP assignment, attendance, required documents, conferences, etc
Maintains and updates demographic and clinical support information (prior authorizations, pre-certifications, etc.) in data management platform and prepares reports as scheduled
Requests prior authorizations and/or pre-certifications for services as required by funders including monitoring to ensure prior authorizations and/or pre-certifications are current and align with recommendations for treatment
Respond to requests for additional information from insurance funders

Fulltime

New

Medical Customer Service Rep

We are looking for a compassionate and detail-oriented Medical Customer Service ...

Location

United States , Minneapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Previous experience in a call center or customer service role, preferably within healthcare or health insurance
Working knowledge of Medicaid, Medicaid eligibility, claims processing, and member service practices
Familiarity with prior authorization processes and provider network navigation
Strong verbal communication skills with the ability to explain complex benefit information in a simple, helpful manner
Comfortable managing a high volume of calls while maintaining accuracy, professionalism, and attention to detail
Ability to document information clearly and use customer service systems efficiently
Proven ability to handle sensitive situations with patience, discretion, and a member-focused approach

Job Responsibility

Handle incoming calls from health plan members and provide clear explanations related to coverage, benefits, and claim status
Assist callers with questions about amounts owed, including billing concerns and statements issued by healthcare providers
Review member eligibility details and help individuals understand Medicaid-related services and managed care plan information
Guide members through provider network options so they can identify appropriate participating healthcare professionals and facilities
Explain medical authorization guidelines and help members understand when prior approval may be required for certain services
Support members with coordinating transportation arrangements and navigating scheduling options tied to their health plan benefits
Document customer interactions thoroughly and maintain accurate records of inquiries, actions taken, and follow-up needs
Deliver empathetic, high-quality service while meeting standards in a high-volume customer support environment

What we offer

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

Fulltime

Technical Product Manager III

The Technical Product Manager (TPM) III serves as a strategic bridge between bus...

Location

United States , Los Angeles

Salary:

207808.00 - 353272.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Bachelor's Degree in Computer Science or Related Field
At least 10 years of experience in a health plan, payer organization and/or health system, ideally as a Technical Product Management or similar role
Experience in at least one of the following healthcare domains: Customer Engagement / Front Office Operations: enrollment and eligibility, call center, member/provider portals, member outreach, appeals and grievances, sales/marketing portals
Health Services Delivery and Quality Oversight: care management, population health, behavioral health, pharmacy, UM authorizations, quality oversight
Provider Network Operations / Data: provider portals, provider data management & network operations enablement, Prior Authorization Interoperability (PAI) submission workflows
Finance / Claims / HR / Compliance Enablement: claims processing & payments, payment integrity, encounter processing, billing/reporting, HR/compliance systems
Proven experience translating complex business needs into clear problem statements that enable technically ready requirements for IT and development teams
Experience delivering enterprise digital solutions that improve member and provider experience, operational efficiency, and maintain regulatory compliance
Experience with agile product management frameworks, backlog prioritization, sprint planning and related tools, including prior exposure to health plans or health system digital solutions
Experience collaborating with cross-functional business and IT teams to drive enterprise solution delivery and ensure alignment with organizational priorities

Job Responsibility

Leads business stakeholders in defining product vision, solution intent, scope, value hypothesis, and roadmap aligned with enterprise strategy and measurable business outcomes
ensures enterprise-wide impact and alignment across multiple business verticals and strategic objectives, while owning one or more domains and coordinating cross-domain roadmaps in collaboration with other TPMs
Drives the translation of complex business needs into clear problem statements and outcomes that inform technically ready requirements for IT and development teams
Ensures requirements are accurate, complete, timely, and aligned with defined success metrics to support product strategy and enterprise delivery of business value
Partners with internal teams ensure business requirements and product intent are clearly understood and proposed solutions align with enterprise reference architecture and governance standards
Provides guidance and oversight to ensure requirements are technically ready and aligned with product strategy and evaluates integration dependencies and trade-offs across systems
Collaborates with key stakeholders to ensure the product backlog for the domain is effectively prioritized, supports other TPMs with cross-domain backlog coordination, and participates in sprint planning and review sessions to maintain strategic alignment
Manages the delivery of quality and member-focused digital solutions
Ensures the business units understand the technology solution, overall solution delivery, and compliance with governance processes, architecture standards, as well as their roles and accountabilities in each phase of the delivery cycle
Provides oversight for testing, validation, and deployment activities to ensure solutions align with business intent, success metrics, and regulatory requirements, while advising teams on enterprise-level expectations

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Patient Care Coordinator

We are looking for a detail-oriented Patient Care Coordinator to support financi...

Location

United States , Plymouth

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High school diploma or equivalent required
At least 6 months of experience performing insurance or benefit verification in a healthcare business office, insurance operations, or similar setting
Hands-on knowledge of healthcare front-end revenue cycle workflows, including eligibility review, benefit interpretation, and patient financial clearance
Familiarity with commercial insurance, Medicare, and Medicaid plan structures, coverage rules, and patient liability determination
Experience using EMR or EHR platforms
Epic is preferred
Ability to work effectively with clinical teams and interpret clinical documentation related to services and procedures
Strong written and verbal communication skills with the ability to explain financial information clearly and professionally
Prior exposure to retail pharmacy, prior authorization, billing work queues, or related payer operations is preferred

Job Responsibility

Review insurance coverage for upcoming services and document verification details accurately within the electronic health record
Evaluate active benefits, policy effective dates, service limitations, authorization requirements, and expected patient out-of-pocket responsibility
Prepare patient-friendly cost estimates and explain financial obligations before scheduled visits, procedures, or stays
Identify insufficient coverage situations and connect patients or families with financial counseling or available assistance programs
Support prior authorization and payer-related clearance activities to help reduce delays, denials, and reimbursement issues
Manage assigned work queues efficiently while meeting established productivity and quality standards in a high-volume setting
Collaborate with clinical and revenue cycle teams to clarify documentation, resolve coverage questions, and support timely patient access
Provide guidance to less experienced colleagues when needed on payer rules, benefit interpretation, and financial clearance processes
Complete additional business office tasks and special assignments as needed to support departmental operations

What we offer

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

Fulltime

Patient Care Coordinator

We are looking for a Patient Care Coordinator to support claims resolution and f...

Location

United States , Plymouth

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Background in healthcare revenue cycle work, with particular strength in front-end financial clearance or claims support functions
Practical experience with insurance verification, prior authorization, denial-related follow-up, and billing work queues
Ability to interpret commercial insurance, Medicare, and Medicaid benefits and apply that information accurately to patient accounts
Familiarity with Epic or other EMR/EHR platforms used to document eligibility, coverage, and account activity
Strong written and verbal communication skills, with the ability to explain financial information clearly to patients and internal teams
Knowledge of medical terminology, clinical procedures, and patient financial responsibility calculations
Proven ability to work independently in a high-volume, productivity-focused environment while maintaining accuracy and attention to detail

Job Responsibility

Investigate and correct claim issues caused by incomplete, inaccurate, or missing billing information so accounts can move forward for timely submission
Enter charges manually by compiling demographic details, insurance data, and visit information from multiple sources to support accurate fee billing
Review coverage status and confirm that active insurance applies to scheduled services, procedures, or visits before billing is processed
Interpret plan benefits, coverage limits, effective dates, authorization rules, and patient cost obligations for upcoming care
Complete eligibility checks through available verification tools and record all findings clearly within Epic or other applicable electronic systems
Provide patients with understandable cost estimates and explain expected out-of-pocket expenses related to their care
Guide patients and families toward financial assistance or counseling resources when insurance coverage is limited or insufficient
Communicate important patient-facing policies and required documentation details when clarification is needed during the financial clearance process
Support productivity goals in a high-volume workflow while collaborating with team members on escalated payer or account issues
Share knowledge with colleagues by offering guidance on payer requirements, revenue cycle processes, and billing-related questions

What we offer

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

Patient Care Coordinator

We are looking for a detail-oriented individual to support patient access and fi...

Location

United States , Minneapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience in healthcare revenue cycle operations, with emphasis on front-end financial clearance, pre-registration, or related patient access functions
Strong background in insurance verification, benefits review, prior authorization support, and interpretation of patient liability for healthcare services
Working knowledge of commercial insurance, Medicare, and Medicaid plans, including coverage rules, limitations, and coordination considerations
Proficiency with EMR or EHR platforms, with Epic experience required
Ability to perform effectively in fast-paced, productivity-focused settings while maintaining a high level of accuracy and attention to detail
Solid understanding of medical terminology, healthcare procedures, and billing-related workflows
Effective written and verbal communication skills, with the ability to explain financial information to patients in a clear and thorough manner

Job Responsibility

Conduct pre-registration conversations with patients to gather demographic, insurance, and service-related details, then enter complete and accurate information into Epic
Review active insurance coverage for scheduled visits or admissions by completing eligibility checks and documenting verification results in the appropriate system
Analyze plan benefits for upcoming services, including effective dates, limitations, authorization needs, and potential patient payment obligations
Prepare and communicate cost estimates so patients have a clear understanding of anticipated financial responsibility before care is delivered
Explain applicable patient-facing policies and required documentation, including treatment-related acknowledgments, general rights information, and other registration materials
Identify situations involving limited or insufficient coverage, discuss available assistance options, and connect patients with financial counseling or government support resources when appropriate
Provide guidance to newer team members by sharing knowledge related to payer requirements, revenue cycle processes, and issues that affect financial clearance outcomes
Support additional operational tasks as needed to help maintain workflow quality, productivity, and service standards in a high-volume environment

What we offer

Medical insurance
Vision insurance
Dental insurance
Life insurance
Disability insurance
401(k) plan

Fulltime

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Medicaid Prior Authorization Coordinator

Job Description

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