Medicaid Prior Authorization

Job Overview

CT18 Group LLC, a behavioral health agency, is seeking a detail-oriented Medicaid Prior Authorization & Insurance Verification Specialist to support service access and billing accuracy for our clients. This position is responsible for verifying Medicaid eligibility, benefits, and obtaining prior authorizations for all behavioral health services. The ideal candidate will have direct experience working with North Carolina Medicaid Managed Care Organizations (MCOs) and a strong understanding of behavioral health authorization processes and documentation standards..

Key Responsibilities

• Verify Medicaid eligibility and coverage through NCTracks, MCO portals, and other verification systems daily.
• Obtain and track prior authorizations and re-authorizations for behavioral health services including therapy, community support, case management, and peer support.
• Ensure all authorizations meet North Carolina Medicaid and MCO policy requirements and accurately reflect current service codes and units.
• Communicate approval dates, authorized units, and service limits to clinical and billing teams to prevent denials or service lapses.
• Maintain and update authorization logs within the agency's Electronic Health Record (EHR) and billing system.
• Follow up on pending authorizations, denials, or expired authorizations; coordinate with MCO representatives to resolve discrepancies promptly.
• Prepare and submit required documentation for utilization reviews and medical necessity requests when needed.
• Support compliance by ensuring all authorizations and eligibility records are up-to-date for audits or Medicaid reviews.
• Collaborate closely with clinical staff to align service delivery with authorization limits and renewal timelines.
• Maintain confidentiality and adhere to HIPAA and agency privacy policies.

Qualifications

• High school diploma or GED required; Associate's degree preferred.
• Minimum 1 year of experience working with Medicaid authorizations or eligibility in a behavioral health or healthcare setting.
• Strong working knowledge of NC Medicaid Managed Care Organizations (MCOs) such as Alliance Health, Partners, Trillium, Vaya, or Carolina Complete.
• Familiarity with NCTracks and MCO provider portals (e.g., AuthentiCare, ProviderConnect, or Availity).
• Proficient in electronic health records (EHR) and Microsoft Office (Excel, Outlook, Word).
• Excellent communication skills, attention to detail, and ability to meet deadlines.
• Strong problem-solving skills with the ability to follow up and resolve payer issues independently.
• Experience with behavioral health CPT/HCPCS codes (e.g., H2015, 90837, 90847, H0038, etc.) preferred.
• Knowledge of prior authorization timeframes, re-auth procedures, and documentation requirements under NC Medicaid rules.

Preferred qualifications

• Previous experience in insurance verification processes.
• Background in dental office operations is a plus.
• Excellent organizational skills with attention to detail.
• Strong communication skills, both verbal and written, to effectively interact with diverse stakeholders.

Why you'll love it here

We're dedicated to fostering an environment where our team members can thrive both professionally and personally. Our commitment to your well-being is reflected in our comprehensive benefits package designed to support you at every stage of your career.

Our benefits include:

• Competitive pay structure
• Comprehensive health benefits
• Supportive resources for mental health and wellness

About us

Join our dynamic team where we are passionate about making a difference in the lives of our patients. We believe that by empowering our employees, we can create a positive impact on healthcare delivery. Together, we strive for excellence in service while upholding the highest standards of integrity and compassion.

Job Type: Part-time

Pay: $ $25.00 per hour

Expected hours: 30 per week

Benefits:

• Paid time off

Work Location: Hybrid remote in Charlotte, NC 28208