Description
Position Summary
GA Foods is seeking a detail-driven Prior Authorization Specialist to support our Accounts Receivable/Revenue Cycle Management team. This role is critical to ensuring payer authorizations are secured, accurate, compliant, and aligned with services delivered—protecting revenue and preventing avoidable claim denials.
This position owns the prior authorization process from start to finish, working cross-functionally with Care Center, Billing, Collections, and payer portals. The ideal candidate understands how authorizations flow through the revenue cycle and can proactively manage requirements, renewals, and documentation to keep services uninterrupted and reimbursable.
Key Responsibilities
Submit and manage prior authorization requests for home-delivered meal services across Medicaid, Medicare Advantage, and managed care plans
Verify authorization requirements by payer, plan, state, and service type
Ensure authorizations are obtained prior to service start dates when required
Monitor authorization statuses daily and follow up proactively to prevent service gaps or denials
Manage renewals, extensions, and changes to existing authorizations
Review and validate medical necessity documentation, physician orders, assessments, and care plans to ensure payer compliance
Maintain accurate and complete authorization records, including authorization numbers, approved CPT/HCPCS codes, units, frequency, and service date ranges
Ensure compliance with CMS, state Medicaid, and payer-specific guidelines
Communicate authorization approvals, denials, and pending statuses to Care Center, Billing, and Collections teams
Partner with care coordination and case management to resolve missing, incomplete, or incorrect documentation
Escalate urgent or high-risk authorization delays that could impact service delivery or reimbursement
Identify authorization-related denial trends and recommend process improvements
Provide authorization support and documentation for denied claims, resubmissions, and appeals
Correct authorization, demographic, or diagnosis-related errors to support timely resolution
Track authorization turnaround times, approval rates, and renewal timeliness
Maintain productivity and accuracy metrics
Support internal audits, payer reviews, and compliance checks as needed
Required Qualifications
13 years of prior authorization experience
Experience working with Medicaid and/or Medicare Advantage plans
Familiarity with payer portals and authorization workflows
Strong attention to detail and organizational skills
Ability to manage high volumes in a fast-paced, deadline-driven environment
Experience in home health, DME, Meals-on-Wheels, or ancillary services
Knowledge of CPT/HCPCS codes related to nutrition or ancillary services
Experience working with multi-state Medicaid plans
Prior experience with authorization software or revenue cycle management (RCM) systems
Equal Opportunity Statement: At GA Foods, we are deeply committed to the principles of equal employment opportunity. It is our policy that all employment decisions are made without discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetics, disability, veteran status, or any other characteristic protected by local, state, or federal law. We base all employment decisions on merit, qualifications to perform the essential job functions (with or without reasonable accommodations), and business needs. GA Foods also provides affirmative action in employment for qualified individuals with disabilities and protected veterans, in compliance with Section 503 of the Rehabilitation Act and the Vietnam Era Veterans' Readjustment Assistance Act.
GA Food Services of Pinellas County, LLC (GA Foods) is proud to be a Drug-Free, Smoke-Free Workplace and an Equal Employment Opportunity Employer.
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