Authorization Specialist: Medical Records & Compliance

Lakeland Care, Inc.; Fond du Lac (WI); On-site; USD 42,000 - 60,000; Full time

Job summary

Responsibilities include auditing authorizations, assisting with coding accuracy, and guiding best practices for correct documentation and timely member services. This position emphasizes collaboration, quality improvement, and adherence to Lakeland Care’s standards.

Qualifications

• Associate degree or specialized training in Medical Records or related field, or equivalent experience.
• 1 year of experience in medical billing or insurance authorization preferred.
• Strong understanding of service authorization guidelines and procedures.
• Knowledge of Lakeland Care’s electronic member records system is essential.
• Familiarity with CPT, ICD-9, ICD-10 coding and Medicare/Medicaid is preferred.
• Excellent verbal and written communication with internal and external partners.

Responsibilities

• Enter and modify service authorizations accurately in the electronic member record system.
• Conduct authorization audits and remediate findings to ensure proper claims payment.
• Support IDT by providing resources and guidance on best practices.
• Review provider information, SNF HIPPS codes, and TIN changes to prevent delays.
• Communicate effectively under pressure and maintain teamwork at all times.
• Apply Standard Practice Codes (SPCs) to ensure correct claims processing.

Skills

Medical Records

Medical Coding

CPT/ICD

Medicare/Medicaid

Education

Associate Degree in Medical Records

Tools

MS Word

Spreadsheets

Email

Internet

Job description

Responsibilities include auditing authorizations, assisting with coding accuracy, and guiding best practices for correct documentation and timely member services. This position emphasizes collaboration, quality improvement, and adherence to Lakeland Care’s standards.