Claims & Authorization Specialist

The Claims Specialist is responsible for the submission, tracking, and reconciliation of healthcare claims through managed care organizations. Works closely with internal teams, requiring clearcommunication to ensure claims are submitted accurately, tracked effectively, and approved and reimbursed in full. Managing insurance authorizations and related electronic health record (EHR) updates for Medicaid clients eligible for the Housing Supports Program. This role serves as a first point of contact, requiring strong  customer service skills, accuracy, and confidence working across multiple healthcare systems.

The position supports clients who are homeless or at risk of homelessness and works closely with internal teams to ensure timely authorization, accurate data entry, and compliance with payer and state requirements, achieve a 100% clean claim and reimbursement rate, supporting revenue integrity and operational efficiency.

This is a full-time role , on a US shift, and in the office set-up.

If you have the right skill set, this may be your opportunity to enter this fast-growing organization.

DUTIES AND RESPONSIBILITIES:

• Submit healthcare claims through Availity or United Healthcare Portal to managed care
  organizations (MCOs)
• Monitor and track claim status from submission through reimbursement
• Identify and resolve claim rejections, denials, or errors
• Coordinate with internal teams to ensure claim accuracy and completeness
• Maintain detailed records of claims activity and outcomes
• Support internal audits and compliance checks related to claims processing
• \Ensure all claims meet payer, and regulatory requirements
• Housing Supports Program (HSP) eligibility screening
• Complete Initial Assessment Tool (IAT) and Level of Need (LON) assessments with the clients
• Submit and manage insurance authorizations to managed care organizations (MCOs)
• Track authorization status and follow up as needed to ensure timely approvals
• Maintain accurate and up-to-date client records in electronic health record systems (HMIS)
• Enter and update demographic and service-related data in state systems (HMIS)
• Assign and schedule client follow-up with GSH staff
• Communicate professionally with internal staff and external stakeholders as needed
• Ensure documentation accuracy and compliance with healthcare and payer requirements
• Maintain confidentiality and handle sensitive client information appropriately

Required Skills & Qualifications:

• Experience in healthcare claims processing (required)
• Prior experience using Availity (required)
• Strong attention to detail and administrative accuracy
• Comfortable working with healthcare data and financial records
• Ability to manage high-volume, repetitive workflows
• Organized and process-driven mindset
• At least 1 year of experience handling Medicaid authorizations
• Prior experience using Availity (strongly preferred)
• Experience working with electronic health records (EHR) systems
• Strong attention to detail and data accuracy
• Solid customer service and communication skills
• Comfortable working across multiple systems and platforms