Prior Authorization Specialist

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.

• 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

• 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.

PI