Service Authorization Coordinator

Role Summary: The Service Authorization Coordinator supports the timely coordination and accurate processing of Medicaid-funded services for MI Choice Waiver, Self-Determination, and Community Transition Services (CTS). This position manages service authorization records, coordinates billing and documentation reviews, works with contracted vendors to resolve discrepancies, and monitors Electronic Visit Verification (EVV) and program compliance. Through accurate recordkeeping, data analysis, and provider collaboration, the Coordinator helps promote regulatory compliance, efficient operations, and reliable service delivery.

Responsibilities and Duties

• Coordinate the review, processing, and tracking of Purchase of Service (POS) requests within Compass for MI Choice Waiver and Community Transition Services.
• Coordinate and maintain service authorization processes for Self-Determination services, ensuring authorizations are accurate, timely, and aligned with program requirements.
• Maintain accurate authorization records and tracking tools to support timely processing, service delivery, and reporting.
• Process billing for Community Transition Services in accordance with established program requirements and departmental procedures.
• Serve as a point of contact for contracted vendors regarding service authorizations, billing, Electronic Visit Verification (EVV), documentation, and compliance requirements.
• Cross-reference vendor notices and POS requests with vendor invoices to verify that billed services are authorized, appropriate, and accurately documented.
• Communicate identified discrepancies to vendors and internal staff and support timely resolution of authorization, billing, and documentation issues.
• Monitor Electronic Visit Verification (EVV) processes for contracted vendors and services subject to EVV requirements, identifying, tracking, and reporting discrepancies and trends to management.
• Review vendor adherence to EVV documentation standards, including the timely and accurate recording of service delivery, visit validation, and billing documentation.
• Assist with EVV audits, reporting, and compliance activities, including the timely submission of required information and follow-up on identified discrepancies.
• Complete annual on-site Home and Community-Based Services (HCBS) residential setting surveys, as assigned, to assess contracted housing vendors' adherence to applicable HCBS requirements.
• Analyze authorization, billing, EVV, vendor, and documentation data to identify recurring issues, discrepancies, and trends.

Required Knowledge, Skills and Abilities

• Proficiency with Microsoft Office Suite, including Excel, Word, Outlook, and SharePoint; experience with Compass or similar authorization/case management systems preferred.
• Strong analytical, organizational, time management, and problem-solving skills, with the ability to interpret data, identify trends, manage multiple priorities, and meet deadlines
• Effective written and verbal communication skills, including the ability to present findings, prepare reports, and communicate recommendations to leadership.
• Strong data entry and data management skills, with the ability to maintain accurate records and use electronic tracking and reporting tools.
• Knowledge of Medicaid waiver programs, MI Choice, Self-Determination, Home and Community-Based Services (HCBS), and related service authorization and documentation requirements preferred.
• Knowledge of Electronic Visit Verification (EVV), HIPAA, HCBS requirements, and applicable federal and state compliance standards.

Education and Experience

• Education: Bachelor’s degree in business, Healthcare Administration, Human Services, Public Administration, Health Information Management, Health Services Administration, or a related field preferred. Equivalent combination of education, training, and relevant experience may be considered.
• Experience: Two (2) years of relevant experience in healthcare administration, Medicaid services, service authorization, billing, compliance, care management, Home and Community-Based Services, provider relations or a related field. Experience with Medicaid waiver programs, EVV, provider billing, or authorization systems preferred.
• Requirements: Must possess a valid Michigan Driver’s License, current automobile insurance, and reliable transportation.