Care Authorization Specialist — Quality & Compliance

Lakeland Care Inc.; Fond du Lac (WI); On-site; USD 42,000 - 64,000; Full time

Job summary

Lakeland Care Inc. in Wisconsin is seeking a Service Authorization Specialist to manage authorizations in our electronic member records system.

Under supervision, you will ensure authorizations reflect IDT determinations and comply with policy and documentation requirements. You will review guidelines, verify provider information, monitor quality and compliance, coordinate with claims as needed, and provide resources to IDT staff on best practices to ensure accurate authorizations and timely

Qualifications

• Associate degree or specialized training in Medical Records or Medical Coding, or equivalent experience.
• 1 year of experience in medical billing or insurance authorization preferred.
• Strong understanding of service authorization guidelines, policies and procedures.
• Knowledge of Lakeland Care’s electronic member records system.
• Knowledge of CPT, ICD-9 and ICD-10 coding.
• Knowledge of Medicare, Medicaid preferred.
• Excellent verbal and written communication; attention to detail.

Responsibilities

• Enter and modify service authorizations accurately in the Lakeland Care EMR, aligning with policy requirements.
• Conduct routine authorization audits and remediate findings to ensure accurate payments.
• Contribute to quality improvement within the service authorization process.
• Review documentation/provider information to prevent delays in member services.
• Coordinate with claims as needed to ensure accurate authorizations and payments.

Skills

Medical Billing

Insurance Authorization

CPT/ICD coding

Communication

Attention to detail

MS Office

Driver's license

Education

Associate Degree in Medical Records / Medical Coding

Tools

Lakeland Care EMR

Job description

Lakeland Care Inc. in Wisconsin is seeking a Service Authorization Specialist to manage authorizations in our electronic member records system.

Under supervision, you will ensure authorizations reflect IDT determinations and comply with policy and documentation requirements. You will review guidelines, verify provider information, monitor quality and compliance, coordinate with claims as needed, and provide resources to IDT staff on best practices to ensure accurate authorizations and timely