Intake & Authorizations Specialist

About the role

The Specialist initiates the intake process by reviewing and validating all incoming referrals to ensure eligibility under the EEOICPA program. This includes confirming white card status, ICD codes, treating physician assignment, AR involvement, and required demographic and clinical data. Once verified, the Specialist inputs referral information into internal systems, flags missing documents, and initiates the patient record in accordance with agency protocols. They collaborate with Business Development and Clinical staff to ensure timely follow-up, accurate documentation, and appropriate scheduling for TP visits. Specialists are also responsible for tracking referral status and communicating updates to stakeholders across departments.

Responsibilities

• Referral Intake Processing and Data Verification
• Authorization File Preparation and Documentation
• Coordination LOMN and Development Drafting
• DME Tracking and Care Planning
• Communication, Training Support, and Cross-Departmental Engagement

Requirements

• Required Qualifications:
• Associate’s or Bachelor’s degree in a healthcare-related field (e.g., Nursing, Health Sciences, Medical Administration, Health Information Management) or equivalent combination of education and directly related experience.
• Minimum of 3–5 years of experience in healthcare intake, authorizations, utilization management, or clinical documentation support within a regulated healthcare environment.
• Demonstrated clinical experience drafting or supporting Letters of Medical Necessity (LOMNs), including the ability to translate clinical conditions, functional limitations, disease progression, and skilled care needs into defensible written justification.
• Working knowledge of government-funded or highly regulated programs that require detailed, evidence-based justification for medical services (e.g., EEOICPA, CMS-regulated programs, Medicaid, VA, or similar).
• Proven experience assembling and coordinating authorization packets, including Plans of Care, physician documentation, clinical assessments, DME justification, and supporting test results.
• Strong written communication skills with the ability to support defensive documentation that withstands medical review, development requests, and audits.
• High level of attention to detail and ability to manage multiple timelines, deadlines, and documentation requirements simultaneously.
• Proficiency with electronic medical records (EMRs), document management systems, spreadsheets, and workflow tracking tools.
• Preferred Qualifications:
• Clinical background as an RN, LPN, Medical Assistant, or other licensed/credentialed clinical role.
• Prior experience with Workers’ Compensation or federal authorization processes, including medical necessity review, utilization review, or appeal support.
• Direct experience responding to development letters, denials, or requests for additional justification, including revising LOMNs and compiling supplemental clinical evidence.
• Familiarity with conditions requiring complex justification (e.g., pulmonary disease, chronic pain, functional decline, mobility impairment, oxygen dependency, DME-driven care needs).
• Experience supporting programs that require objective clinical data (e.g., PFTs, 6MWTs, physician narratives, medication side-effect justification) to substantiate care hours.
• Exposure to audit-ready documentation standards and compliance-driven workflows.

Qualifications

• Education and Experience

Skills

• Attention to Detail
• Collaboration
• Communication
• Documentation
• Regulatory Awareness
• Time Management

Benefits

• Comprehensive medical, dental, vision, 401k, holiday pay, unlimited PTO benefits package
• Employee Referral Program
• Employee Assistance Program
• Short-term and Long-term Disability
• Basic Life Insurance
• Six (6) paid holidays
• Professional development and growth opportunities
• Dynamic and supportive work environment

Pay

$65,000-$75,000/year

Schedule

Hybrid, Full-time, Monday - Friday position