Managed Care Authorization Specialist

Majestic Care; Westfield (IN); On-site; USD 40,000 - 55,000; Full time

Job summary

Majestic Care is looking for a Managed Care Authorization Specialist to manage authorizations and ensure compliance with regulatory standards. The role involves verifying benefits, collaborating with the therapy team, and maintaining documentation. Ideal candidates will hold a required HFA license and have relevant experience.

Qualifications

• Bachelor’s degree preferred; HFA license required.
• 1-2 years relevant experience preferred.
• Experience with PCC, Availity, and insurance portals beneficial.

Responsibilities

• Manage Part B, outpatient, and Custodial Care authorizations.
• Verify benefits using insurance portals and maintain documentation.
• Ensure compliance with CMS, state, and federal regulations.

Skills

HIPAA compliance

Documentation

Collaboration

Education

Bachelor’s degree in a related field

HFA license

Nursing license (RN or LPN)

Tools

PCC

Availity

Insurance portals

Job description

Join to apply for the Managed Care Authorization Specialist role at Majestic Care

Majestic Care is seeking an Authorization Specialist to support our mission and uphold our core values:

• Our mission: Through the hearts of our Care Team Members, we provide excellent healthcare to those we serve.
• Core Values: Listening, Empathy, Accountability, Decisiveness

This role involves managing Part B, outpatient, and Custodial Care authorizations, including verifying benefits, determining authorization needs, and collaborating with the therapy team to ensure compliance with CMS, state, and federal regulations.

Essential Responsibilities:

• Determine if authorization is required for services/items requested.
• Request all necessary authorizations with documentation.
• Manage updates/extensions and submit them timely.
• Enter authorization data into EMR (PCC).

Verification & Documentation:

• Verify benefits using insurance portals/websites.
• Obtain required documentation from the therapy team.
• Maintain HIPAA compliance and regulatory adherence.

Qualifications:

• Bachelor’s degree in a related field preferred.
• HFA license required; Nursing license (RN or LPN) preferred.
• 1-2 years relevant experience preferred.
• Experience with PCC, Availity, and insurance portals beneficial.

Additional Details:

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Healthcare Provider