Authorization Specialist

Job Title: SCO and One Care Authorization Specialist

Business Unit: Administration

Department: Fiscal

Reports to: Director of Revenue

FLSA: Non-Exempt

Classification: Full Time (35 hours)

Grade: 9

Salary Range: $50,000 - $60,000

SUMMARY OVERVIEW

The SCO/One Care Authorization Specialist plays a critical role in supporting the coordination, processing, and management of service authorizations for consumers enrolled in SCO and One Care programs. This position works collaboratively with internal operational teams, providers, insurance carriers, and community-based partners to ensure authorizations are processed accurately, timely, and in compliance with payer requirements. Our ideal candidate is highly organized, detail oriented, and able to manage a high-volume workload within a fast-paced healthcare environment. This individual demonstrates strong follow through, professionalism, and the ability to prioritize time sensitive workflows while maintaining accuracy and responsiveness. This individual remains committed to supporting high quality services for consumers within the ASAP network and broader home care community. The SCO/One Care Authorization Specialist will focus on getting the job done right, the first time. Experience in the healthcare industry and strong communication skills related to obtaining authorizations, collaborating with insurance companies, and supporting cross functional operational workflows are essential to this role.

ESSENTIAL FUNCTIONS

Duties 1-10 are designated as ADA essential functions and must be performed in this job. All other job duties are secondary functions.

1. Process and manage incoming authorization documentation including approvals, renewals, increases/decreases, suspensions, and terminations.
2. Monitor daily authorization dashboards, electronic fax queues, and payer communications to ensure all authorizations and documentation are received, processed, and routed timely.
3. Maintain accurate authorization and consumer records within applicable systems, trackers, and payer portals.
4. Coordinate with care teams, providers, fiscal staff, and insurance carriers regarding authorization updates and required follow up actions.
5. Review and route suspension and termination notifications to appropriate operational staff.
6. Assist with monthly authorization reconciliation, denial review, and error reporting processes.
7. Complete and maintain authorization reports for SCO and One Care plans.
8. Support operational readiness related to service authorizations during consumer transitions, onboarding initiatives, and enrollment growth.
9. Identify workflow discrepancies, missing documentation, or authorization delays and escalate issues proactively to management.
10. Maintain compliance with payer authorization requirements, internal workflows, and documentation standards while managing a high-volume workload with accuracy and timeliness.

COMPETENCIES

• Knowledge of healthcare authorization workflows, managed care operations, or healthcare administrative systems.
• Strong computer skills, especially Microsoft Excel (Pivot tables, V-Lookups, etc.).
• Experience working with multiple systems, dashboards, spreadsheets, and tracking tools simultaneously.
• Strong ability to prioritize urgent authorization requests, suspensions, and terminations while maintaining accuracy.
• Comfortable processing and organizing large volumes of electronic documentation and communications.
• Ability to identify workflow discrepancies and proactively escalate issues for resolution.
• Strong follow through and time management skills with minimal supervision.
• Team player with a willingness to collaborate across departments.
• Ability to communicate effectively across operational, clinical, provider, and fiscal teams regarding authorization status and follow up needs.
• Character of integrity and dependability.
• Above average organizational skills with a keen ability to prioritize.
• Proactive and resourceful.
• Positive attitude and willingness to support team objectives.
• Ability to manage multiple tasks concurrently and switch gears seamlessly.
• Attention to accuracy and detail.

SUPERVISORY RESPONSIBILITY

This position has no supervisory responsibilities.

WORK ENVIRONMENT

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, printers, copiers, filing cabinets.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

• The employee must be able to carry 10 to 15 lbs.
• The employee is regularly required to talk and hear.
• The employee is frequently required to stand, walk, use hands to finger, handle or feel, and reach with hands and arms.

POSITION TYPE/EXPECTED HOURS OF WORK

This is a full-time position, Monday-Friday, 9 a.m. - 5 p.m. Hybrid work schedule; Minimum of two days per week onsite is required.

REQUIRED/PREFERRED EDUCATION AND EXPERIENCE

• Healthcare administrative, authorization, billing, or managed care experience required.
• Excel/spreadsheet experience required.
• Microsoft Office Suite familiarity required.
• Understanding of home care, healthcare, or managed care environments required.
• Experience with SCO, One Care, Medicaid, or MassHealth managed care plans preferred.
• Experience processing healthcare authorizations, referrals, or utilization management workflows preferred.
• Experience in home care, ASAP, LTSS, or community-based healthcare settings preferred.
• Experience handling high volume administrative healthcare operations preferred.
• Familiarity with authorization tracking systems, electronic fax workflows, and payer portals preferred.
• Experience reviewing authorization discrepancies, denials, or service authorization reporting preferred.

ADDITIONAL ELIGIBILITY QUALIFICATIONS

None required for this position.

WORK AUTHORIZATION/SECURITY CLEARANCE

• Must be able to work in the United States

AAP/EEO STATEMENT

Equal Employment Opportunity/Affirmative Action/Male/Female/Veteran/Disabled – Boston Senior Home Care affirms and supports diversity and inclusion in our workforce and recognizes all EEOC Factors.

OTHER DUTIES

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.