Maternity Care Authorization Specialist

JOB SUMMARY

The Maternity Care PRIA Specialist is a vital member of the Maternity Care team. This role ensures that all maternity-related medical bills are reviewed and processed with accuracy, compassion, and integrity. The specialist is responsible for auditing maternity bills, validating clinical documentation, and ensuring compliance with CHM guidelines and quality standards. By doing so, this role directly supports CHM’s mission of walking alongside expectant mothers and families during a pivotal season of life, ensuring their needs are met with excellence and stewardship.

ESSENTIAL JOB FUNCTIONS

• Review and audit maternity-related itemized bills for accuracy (i.e., patient name, benefit code, place of service, date of service, and total charges).
• Confirm member eligibility of coverage and verify membership monthly monetary contributions are current with required documentation.
• Collaborate with maternity care staff and other departments to obtain and validate clinical documentation, ensuring that maternity services and complexity are accurately represented.
• Identify duplicate bills, ineligible amounts, and maternity-related services outside CHM guidelines.
• Audit eligible discounts entered by Authorizers or Advocates for accuracy
• De-escalate or escalate maternity bills to appropriate departments when additional verification or correction is needed.
• Participate in the implementation of policies and procedures for maternity bill processing in alignment with CHM guidelines.
• Recommend improvements to workflows and systems that strengthen maternity care reimbursement processes.
• Provide feedback to leadership regarding trends, billing inconsistencies, or systemic issues specific to maternity care.
• Perform other job duties as assigned by management.

CORE COMPETENCIES & SKILLS

• High attention to detail and accuracy in reviewing medical bills.
• Strong communication skills (written and verbal) to engage with maternity care staff, members, and providers.
• Compassionate, empathetic approach in supporting expectant mothers and families.
• Ability to maintain confidentiality and strict adherence to HIPAA requirements.
• Problem-solving skills to identify billing errors or documentation gaps.
• Collaborative team player, able to work cross-departmentally in a ministry-focused environment.
• Proficiency with Microsoft Office Suite (Outlook, Word, Excel, Access).
• Adaptability and responsiveness in a fast-paced maternity care setting.

EXPERIENCE REQUIREMENTS

• Medical background preferred, with prior experience in billing, auditing, or healthcare reimbursement.
• Familiarity with maternity and obstetric billing codes, services, or processes strongly preferred.
• Previous experience using information systems/applications in a healthcare or billing environment.

EDUCATION

• Required: High School Diploma or equivalent (GED or high school equivalency exam).

PHYSICAL REQUIREMENTS & WORK ENVIRONMENT

• Standard office hours: Monday–Friday, [9:00am – 5:00pm].
• Prolonged periods of sitting at a desk using a computer and telephone.
• Occasional extended hours may be required during high-volume maternity billing periods.
• Onsite role in Barberton, OH.