Managed Care Authorization Specialist

Evergreen Healthcare Group; California (MO); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Health, Dental, Vision Insurance

Generous PTO Package

Employee Assistance Program

Training & Development Opportunities

Job summary

Evergreen Healthcare Group is seeking an experienced Managed Care Authorization Specialist to join our corporate team. You will manage concurrent authorization requests, track them, and communicate with peers, payers, and facility staff to ensure efficient information delivery.

You will assist with initial authorization requests as needed. You will handle data entry into the EMR for patient billing and collaborate with Admissions for insurance verification and case management negotiations.

Qualifications

• Strong experience with Managed Care Insurance Verification.
• Medical Terminology knowledge is desirable.
• Ability to verify insurance and coordinate authorizations with payers and facilities.

Responsibilities

• Data entry into EMR for patient billing and verification.
• Collaborate with Admissions for insurance verification and case management.
• Maintain knowledge of reimbursement principles and pricing parameters.
• Communicate with payor case managers for updates/authorizations.
• Manage and monitor daily to-dos in EMR; assist with projects.

Skills

Microsoft Office suite

Excel

Word

PowerPoint

Outlook

Communication skills

Confidentiality

Education

High school diploma or equivalent

Medical Terminology knowledge

Tools

Electronic Medical Record (EMR) System

Job description

Job Summary

Evergreen Healthcare Group is seeking an experienced and dedicated Managed Care Authorization Specialist to join our team our corporate team. As a key member support team, you will manage concurrent authorization requests and tracking; communicate effectively with peers, payers, and facility staff to confirm efficient delivery of information; and assist with initial authorization requests as needed.

Responsibilities

• Data entry of patient information into the electronic medical record for patient billing.
• Collaborates with Admissions Teams for insurance verification and case management negotiations for patient/payer set ups.
• Maintains knowledge of reimbursement principles and pricing parameters.
• Provides and documents ongoing communication with payor case managers for updates/changes/authorizations.
• Recognizes and notifies supervisor of potential problem referrals.
• Available for on-call responsibilities as assigned.
• Handles client complaints in a fair and empathetic manner.
• Trains new hires and performs remedial training with current staff.
• Manages and monitors “to-dos” in Electronic Medical Record daily.
• Assists Supervisor with projects as assigned.

Other Duties

• Completes annual education requirements.
• Communicates the mission, ethics, and goals of the organization.
• Attends annual review and performs departmental in-services.

Knowledge, Skills, And Abilities

• Ability to maintain patient confidentiality.
• Ability to maintain regulatory requirements, including federal, state, local regulations, and accrediting organization standards.
• Excellent computers skills and application experience within a professional level Microsoft; advanced Excel, Word, Power Point, and Outlook skills required.
• Regularly attend and be punctual for scheduled shift and be in a condition suitable to perform duties of position.
• Ability to organize and prioritize work, use time efficiently, and complete work in a timely matter, guaranteeing that deadlines are met.
• Works at maintaining a good rapport and a cooperative working relationship with physicians, departments, and staff.
• Able to communicate effectively in English, both verbally and in writing.

Education, Licensure, And Experience

• High school diploma or equivalent.
• Three (3) years' experience Managed Care Insurance Verification and Health Care experience required, Medical Terminology desired.
• Managed Care Insurance Verification experience, Skilled Nursing Facility healthcare experience, or Admission/Intake services is preferred.

What We Offer

• Competitive Pay
• Health, Dental, Vision Insurance
• Generous PTO Package
• Employee Assistance Program
• Training & Development Opportunities

At Evergreen, we believe in creating a culture that values compassion, accountability, and growth — for both our residents and our team members. If you're ready to bring your skills to a role where they truly matter, we’d love to hear from you!

Evergreen Healthcare Group is an equal opportunity employer.