Authorization & QA Coordinator

Title: Authorization and Quality Assurance Coordinator

Reports To: Program Director

Location: In-Office, 40 hrs per week (Full-Time)

Schedule: 8 hours per day, Monday-Friday between the hours of 8am and 6pm.

Compensation: $45,000-$55,000 (based on experience and qualifications)

Position Summary

The Quality Assurance & Authorization Coordinator is responsible for ensuring regulatory compliance, overseeing authorization processes, and supporting quality assurance initiatives within an off-site psychiatric rehabilitation program.This role plays a critical part in maintaining program integrity, optimizing service delivery, and ensuring adherence to all applicable state, federal, and accreditation standards. The ideal candidate is highly detail-oriented, organized, and knowledgeable in behavioral health compliance and authorization procedures.

Key Responsibilities

• Quality Assurance & Compliance
• Monitor and ensure ongoing compliance with all applicable regulations and standards, including HIPAA, Maryland state regulations, and CARF requirements
• Maintain quality assurance processes and internal audits
• Identify compliance risks and partner with leadership to implement corrective action plans
• Track, analyze, and report quality metrics and program performance indicators

Authorization Management

• Oversee the authorization process for services, ensuring timely submissions and approvals
• Verify insurance eligibility and coordinate with Maryland Administrative Service Organizations
• Maintain documentation supporting medical necessity and service authorization
• Monitor authorization trends and proactively address denials or delays

Training & Staff Support

• Provide training and ongoing support to staff on documentation standards, compliance requirements, and authorization procedures
• Serve as a resource for regulatory and quality-related questions

Collaboration & Program Improvement

• Collaborate with clinical and administrative leadership to improve workflow efficiency and service quality
• Participate in performance improvement initiatives and program evaluations
• Support audits, site visits, and accreditation reviews

Documentation & Record Management

• Ensure all records are accurate, complete, and audit-ready
• Maintain organized tracking systems for authorizations, compliance metrics, and QA activities

 Performance Expectations

• Maintain at least 95% compliance with all regulatory and accreditation standards
• Achieve and sustain a 90% or higher authorization approval rate
• Demonstrate measurable improvements in quality assurance processes and outcomes
• Provide timely and accurate reporting to leadership
• Deliver effective staff training that results in improved compliance and documentation quality

 Qualifications, Education & Experience

• Associate’s degree in a related field (e.g., healthcare administration, psychology, social work) or equivalent experience required
• Active CPRP
• Minimum of 2 years of experience in a healthcare setting, preferably in quality assurance, compliance, and/or authorization
• Experience in behavioral health or psychiatric rehabilitation programs strongly preferred
• Knowledge of COMAR 10.63, HIPAA, and CARD standards strongly preferred

 Core Competencies

• Strong knowledge of healthcare regulations, compliance standards, and authorization processes
• Excellent organizational, analytical, problem-solving skills, and task prioritization
• Effective communication and interpersonal abilities
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment
• Proficiency in Microsoft Office, Apple products, and electronic health record systems
• High attention to detail and accuracy
• Confidentiality and ethical practices

Work Environment

Office-based role within an off-site psychiatric rehabilitation program. May require occasional participation in audits, meetings, or external reviews. Fast-paced behavioral health setting. Requires handling of confidential and sensitive information daily.

Additional Information

This position description is intended to describe the general nature and level of work being performed. Responsibilities may be adjusted as needed to meet program and organizational goals. All employees are expected to comply with company policies and applicable regulations.