OMHC Prior Authorization Specialist
$9,360–$10,400 year
RemotePhilippines
Job Summary
Collect, review, and verify intake documentation for new client referrals while tracking authorization requests and managing renewals. Submit initial and continuing prior authorizations to payers, monitor status, and follow up to ensure timely approvals. Communicate with clinical providers and administrative teams to obtain missing information, update electronic health records, and notify staff of authorization outcomes. Ensure requirements are completed three business days prior to scheduled services and maintain organized records for audit readiness. Support compliance reporting, quality improvement initiatives, and other departmental projects as assigned.
Required Qualifications
- High school diploma or equivalent
- Ability to successfully complete required background and reference checks
- Minimum of one (1) to two (2) years of experience in healthcare administration, medical prior authorizations, insurance verification, or patient intake coordination
- Knowledge of prior authorization and insurance verification processes
- Familiarity with Maryland Medicaid and Managed Care Organization (MCO) authorization requirements
- Understanding of outpatient behavioral health and medical terminology
- Strong attention to detail and organizational skills
- Excellent time management and ability to manage multiple authorization requests simultaneously
- Strong written and verbal communication skills
- Ability to prioritize tasks and meet strict deadlines
- Proficiency with electronic health records, payer portals, Microsoft Office, and Google Workspace
- Strong problem-solving and follow-up skills
- Ability to work independently in a fast-paced remote environment
- High level of professionalism, confidentiality, and integrity
Desired Qualifications
- Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field
- Experience with outpatient mental health (OMHC), behavioral health, psychiatric rehabilitation (PRP), or primary care authorizations
- Experience working with Maryland Medicaid, Managed Care Organizations (MCOs), or commercial insurance authorization processes
- Experience using electronic health record (EHR) systems and payer portals
- Strong level of professionalism, confidentiality, and integrity
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