Prior Authorization Specialist
$39,520–$46,301 year
Remote · Nelsonville, Ohio, United States
Job Summary
Lead the prior authorization process for outpatient behavioral health, substance use disorder, intensive outpatient, and other covered services, coordinating insurance approvals, submitting documentation to support medical necessity, monitoring timelines and expiration dates, and communicating approval decisions to clinical, billing, and operations staff. Assist with appeals, reconsiderations, and processing of denied or delayed services; verify insurance eligibility across Medicaid, managed care, commercial plans, and OhioRISE; coordinate coverage changes and payer transitions; serve as a liaison among clinical staff, billing, and external partners; develop and improve workflows and tracking for authorizations and insurance navigation; maintain HIPAA compliance and use electronic health records and Microsoft Office in a fast-paced environment.
Required Qualifications
- high school diploma or GED
- associate's or bachelor's degree in human services, social work, or related field preferred
- 2 years healthcare/behavioral health experience preferred
- 2 years prior authorization, insurance verification, utilization review, or healthcare navigation preferred
- strong communication skills
- proficiency with EHR and Microsoft Office
- ability to manage multiple priorities in fast-paced environment
- HIPAA compliance and confidentiality
- knowledge of Medicaid, managed care, OhioRISE, waiver services preferred
- ability to work in a fast-paced environment with deadlines
- prolonged sitting and computer use capability
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