Prior Authorization Operations Associate - Hybrid (Warwick, RI)

Gainwell Technologies LLC•Warwick, RI

9d•$35,000 - $50,000•Hybrid

About The Position

The Prior Authorization Operations Associate processes and maintains prior authorization requests within the Medicaid Management Information System (MMIS), supporting the State of Rhode Island Medicaid Program. The role ensures authorizations are accurately entered, updated, and maintained in accordance with coverage guidelines, program rules, and operational policies. It is primarily operational and administrative rather than clinical, while requiring the ability to interpret coverage criteria and authorization requirements for accurate processing and routing. This hybrid position has on-site days in Warwick, Rhode Island, and works Monday through Friday from 8:30 a.m. to 5:00 p.m.

Requirements

Strong attention to detail and accuracy when processing high volumes of transactions.
Ability to interpret and apply written coverage guidelines, policies, and procedures.
Excellent analytical, problem-solving, and decision-making skills.
Strong organizational and time management skills, including the ability to prioritize tasks and meet required turnaround times.
Effective oral and written communication skills.
Proficiency in Microsoft Office.
Ability to work independently and collaboratively while maintaining professionalism and accountability.

Responsibilities

Process prior authorization requests and updates in MMIS and related systems according to program guidelines and established workflows.
Review authorization requests for completeness, accuracy, and compliance with coverage rules, authorization policies, and submission requirements.
Research and resolve authorization discrepancies, processing errors, and system issues, coordinating with internal teams as needed.
Respond to providers, internal stakeholders, and State partners regarding authorization status, requirements, and operational issues.
Maintain accurate documentation and audit trails; support reporting and reconciliation activities; and ensure compliance with applicable policies, procedures, and regulatory requirements.