Authorization Specialist

Complete Well-Care Source, LLC Authorizations Specialist Job Description

Job Summary

The Authorizations Specialist at Complete Well-Care Source, LLC is responsible for obtaining, monitoring, and maintaining service authorizations in compliance with NC Medicaid and LME/MCO requirements. This role ensures timely service delivery, minimizes denials, supports audit readiness, and maintains strict confidentiality.

Key Responsibilities

The Authorizations Specialist submits, tracks, and follows up on prior authorization requests with NC Medicaid and assigned LME/MCOs in accordance with applicable clinical coverage policies. The Authorizations Specialist verifies eligibility, service limits, authorization periods, and units prior to service delivery.

The Authorizations Specialist maintains accurate authorization records, including service codes, approval dates, units, and expiration timelines, and communicates authorization status to clinical, billing, and administrative staff. The Authorizations Specialist monitors authorizations to prevent lapses, overutilization, or non-authorized services.

The Authorizations Specialist ensures compliance with NC Medicaid Clinical Coverage Policies, LME/MCO guidelines, and Complete Well-Care Source, LLC policies. The Authorizations Specialist protects all protected health information in accordance with HIPAA and Medicaid regulations.

Audit & Compliance Responsibilities

The Authorizations Specialist maintains complete, accurate, and audit-ready authorization documentation. The Authorizations Specialist supports internal and external audits, utilization reviews, and compliance monitoring activities. The Authorizations Specialist identifies and reports authorization discrepancies, documentation gaps, or compliance risks to leadership and assists with corrective actions as needed.

Key Performance Expectations

Authorizations are submitted accurately and within required timeframes to prevent service delays. Authorization approvals, units, and expiration dates are tracked and updated with minimal errors. Communication with clinical and billing teams is timely and clear. Authorization-related denials and service interruptions are minimized. Documentation remains audit-ready and compliant with NC Medicaid and LME/MCO standards. Confidentiality and ethical standards are consistently upheld.

Qualifications

High school diploma or GED required. Prior experience with NC Medicaid, LME/MCOs, or behavioral health authorizations is strongly preferred. Strong attention to detail, organizational skills, and regulatory knowledge are required.

Equal Opportunity Employer

Complete Well-Care Source, LLC is an equal opportunity employer.