IDD Documentation & Authorization Specialist

Job Summary
We are seeking a highly motivated and detail-oriented IDD Documentation & Authorization Specialist to join our dynamic healthcare team. In this role, you will be responsible for managing documentation review, authorization processes, and ensuring compliance with healthcare regulations related to intellectual and developmental disabilities (IDD) services. Your expertise in medical coding, utilization management, and health information systems will be vital in facilitating accurate patient care documentation and authorization workflows. This position offers an exciting opportunity to contribute to quality patient outcomes while navigating complex healthcare policies and regulations.

Responsibilities

• Review medical documentation, including clinical notes, medical records, and care plans, to verify accuracy and completeness in accordance with clinical documentation standards and regulatory requirements.
• Manage authorization requests for IDD services by coordinating with healthcare providers, insurance companies, and regulatory agencies such as Medicaid Services.
• Conduct utilization review and management activities to assess the necessity of services based on clinical guidelines, hospital policies, and long-term care regulations.
• Collaborate with case management teams to facilitate discharge planning, home care coordination, hospice care, or outpatient services while ensuring adherence to health regulation policies.
• Maintain detailed records of authorization decisions, documentation reviews, and communication logs in accordance with HIPAA and state healthcare regulations.

Requirements

• Proven experience with EMR/EHR systems. Must be knowledgeable of WAMS.
• Strong knowledge of managed care processes, Medicaid regulations, CMS guidelines, and long-term care regulations.
• Familiarity with medical terminology, anatomy knowledge, physiology concepts, and clinical documentation standards.
• Experience with medical coding including CPT coding, ICD-9/10 coding systems, and utilization management protocols.
• Knowledge of health information management practices related to inpatient/outpatient settings such as pediatrics or primary care clinics.
• Ability to interpret complex health regulation policies related to HIPAA compliance and state-specific healthcare laws.
• Excellent organizational skills with attention to detail in documentation review and authorization processing.
• Strong communication skills to collaborate effectively across multidisciplinary teams including nursing staff, physicians, case managers, and insurance providers.

Join us in making a meaningful impact by ensuring accurate documentation and timely authorization for essential IDD services! We are committed to fostering a diverse environment where your expertise can thrive while supporting patient-centered care through innovative health information management practices.

Pay: From $25.00 per hour

Expected hours: 15.0 – 25.0 per week

Work Location: In person