Invoice & Service Authorization Specialist – Social Care Network- REMOTE-CONTRACT

ABOUT US Creating Communities of Health and Wellness for ALL We are a network advancing whole person services and supports designed to address health inequities, focus on accessibility, and deliver trauma informed care across the lifespan. Our work covers the spectrum from prevention to complex care. We facilitate partnerships among government, community resources, primary care providers, hospitals, schools, social and behavioral health services, payers and others to ensure everyone has a path to whole person health. Equity and inclusion are a hallmark of how we work. We are intentionally inviting people to join us in creating whole health pathways through co-design emphasizing diversity, equity, inclusion and belonging. Position Summary: The Invoice & Service Authorization Specialist is a key member of the Social Care Network’s operations team, responsible for ensuring the accuracy, compliance, and timeliness of both service authorization and invoice processing. The poisiton is responsible for both reviewing and approving service authorizations and validating invoices related to services delivered through the Social Care Network. This role ensures that all services are properly authorized before delivery, that invoices match authorized services, and that payments are processed in a timely, accurate, and compliant manner. The position requires strong attention to detail, knowledge of Medicaid Managed Care requirements, and the ability to communicate effectively with network providers and internal staff. Key Responsibilities: • Service Authorization: • Review and approve service authorization requests in alignment with Social Care Network guidelines, program contracts, and Medicaid Managed Care requirements. • Verify member eligibility, plan enrollment, and service coverage before authorizing. • Document and track all service authorizations in the network’s database or care management platform. • Communicate approval, denial, or modification decisions to providers promptly and professionally. • Invoice Review & Approval: • Receive and review invoices for completeness, accuracy, and compliance with authorized services. • Match invoices to service authorizations and documented service delivery. • Coordinate with providers and internal teams to resolve discrepancies or missing documentation. • Maintain organized records of all approvals, denials, and adjustments. • Submit approved invoices for payment in accordance with internal timelines. • Compliance & Process Improvement: • Ensure all authorizations and invoice reviews follow Social Care Network, contract, and Medicaid billing standards. • Identify patterns of billing errors or service gaps and recommend process improvements. • Support audit readiness by maintaining accurate and accessible documentation. Qualifications: • High school diploma or equivalent required; associate or bachelor’s degree preferred in business, finance, healthcare administration, or related field. • Experience with service authorization, Medicaid billing, or healthcare claims processing preferred. • Knowledge of Medicaid Managed Care guidelines a plus. • Proficient in Microsoft Office and database systems. • Strong organizational, communication, and problem-solving skills. Core Competencies: • Accuracy and attention to detail. • Accountability for timelines and compliance. • Customer service orientation when working with providers. • Ability to work independently and collaboratively. Compensation: $24–$25/hour Benefits: As a contracted employee, you may be eligible for benefits during the length of the contracted employment which includes paid time off, medical, dental, and vision insurance. Duties • Review and process authorization requests for medical services and procedures. • Verify patient insurance coverage and eligibility through effective communication with insurance providers. • Utilize knowledge of CPT, ICD-9, and ICD-10 coding to accurately document services being requested. • Maintain accurate records of authorizations, denials, and appeals in accordance with HIPAA guidelines. • Collaborate with medical office staff to gather necessary documentation for authorization requests. • Provide exceptional customer service to patients and healthcare providers regarding authorization inquiries. • Stay updated on changes in managed care policies and procedures to ensure compliance. Qualifications • Previous experience in a medical office or dental office setting is preferred. • Strong understanding of managed care processes and insurance verification practices. • Proficiency in medical terminology and familiarity with medical records management. • Experience with CPT coding, ICD coding (ICD-9 & ICD-10) is highly desirable. • Excellent organizational skills with attention to detail. • Strong communication skills, both verbal and written, to effectively interact with diverse stakeholders. • Ability to work independently as well as part of a team in a fast-paced environment. This role is essential for ensuring that patients receive the care they need while navigating the complexities of healthcare authorizations. If you are passionate about supporting patient care through efficient administrative processes, we encourage you to apply. Job Types: Full-time, Contract Pay: $24.00 - $25.00 per hour Work Location: Remote Apply tot his job Apply To this Job