Prior Authorization Operations Associate - Hybrid (Warwick, RI)

About the role

The Prior Authorization Operations Associate is responsible for, with minimal supervision, processing and maintaining prior authorization requests within the Medicaid Management Information System (MMIS). This role supports the State of Rhode Island Medicaid Program by ensuring authorizations are accurately entered, updated, and maintained in accordance with established coverage guidelines, program rules, and operational policies. This position is primarily operational and administrative, not clinical in nature. However, the Associate must be able to interpret coverage criteria and authorization requirements to ensure accurate processing and routing of requests.

Responsibilities

• Process prior authorization requests and updates in MMIS and related systems in accordance with program guidelines and established workflows.
• Review authorization requests for completeness, accuracy, and compliance with coverage rules, authorization policies, and submission requirements.
• Research and resolve authorization discrepancies, processing errors, and system issues while coordinating with internal teams as needed.
• Respond to inquiries from providers, internal stakeholders, and State partners regarding authorization status, requirements, and operational issues.
• Maintain accurate documentation and audit trails, support reporting and reconciliation activities, and ensure compliance with applicable policies, procedures, and regulatory requirements.

Requirements

• Strong attention to detail and accuracy when processing high volumes of transactions.
• Ability to interpret and apply written coverage guidelines, policies, and procedures.
• Excellent analytical, problem-solving, and decision-making skills.
• Strong organizational and time management skills, with the ability to prioritize tasks and meet required turnaround times.
• Effective oral and written communication skills, proficiency in Microsoft Office, and the ability to work independently and collaboratively while maintaining professionalism and accountability.

Schedule

Hybrid position with on-site days located in Warwick, RI. Monday–Friday, 8:30 am–5:00 pm.

Pay

The pay range for this position is $35,000.00 – $50,000.00 per year; base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Benefits

• Generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• Leadership and technical development academies