Medicaid Authorization & Documentation Specialist

Volunteers of American Greater New York•Rahway, NJ

3d•Onsite

About The Position

The Medicaid Authorization Specialist is responsible for supporting program operations by coordinating Medicaid prior authorizations and ensuring documentation is complete and aligned with billing requirements. This position will work closely with Program, Finance/Billing, and Quality Assurance teams to promote high-quality service delivery and timely reimbursement. This position plays a key role in ensuring services are authorized, documentation is accurate, and claims are submitted efficiently to Medicaid Managed Care Organizations (MCOs).

Requirements

Bachelor’s Degree in Healthcare Administration, Social Work, Public Health, or related field.
Minimum of 2–4 years of experience in Medicaid managed care, healthcare, or social services is preferred, including prior authorizations, documentation review.
Experience in behavioral health or community-based programs is preferred.
Experience working with electronic health record (EHR) systems and basic data tracking tools (e.g., Excel) is strongly preferred.
A combination of education and relevant experience will also be considered.
Strong attention to detail, organizational skills, and the ability to manage multiple priorities and deadlines.
Effective communication and problem-solving skills to collaborate with internal teams, funders, and external payers.
Valid driver’s license.

Responsibilities

Obtain, track, and manage Medicaid and MCO prior authorizations and re-authorizations.
Coordinate and support the preparation and submission of appeals for authorization denials.
Serve as a point of contact with MCOs for authorization status, documentation requests, and issue resolution.
Review service documentation to ensure completeness, accuracy, and alignment with payer and billing requirements.
Work collaboratively with program staff to resolve missing, incomplete, or non-compliant documentation.
Conduct concurrent and retrospective chart reviews of medical records and treatment plans to assess documentation quality and appropriateness for services billed.
Collaborate with Quality Assurance and Finance/Billing teams to track, monitor, and report metrics, outcomes, and follow-up actions related to authorizations and documentation.
Maintain logs and tracking tools to support operational oversight, reporting, and audit readiness.
Perform other related duties as assigned to support program operations, documentation compliance, billing readiness, and audit/monitoring requirements.