Prior Authorization Specialist
$39,520–$46,277 year
Remote · Newark, Ohio, United States
Newark, Ohio, United StatesRemoteFull Time$39,520–$46,277 yearMid LevelHigh School Or EquivalentUnknown
Type
Full Time
Level
Mid Level
Education
High School Or Equivalent
Company size
Unknown
Job Summary
Lead the prior authorization process for outpatient behavioral health services, coordinating documentation to support medical necessity, communicating approvals/denials to clinical and billing teams, and assisting with appeals and coverage changes. Requires strong communication, organization, and knowledge of Medicaid/health insurance across multiple plans; position involves HIPAA compliance, coordination with clinical staff, and use of EHR systems.
Required Qualifications
- High school diploma or GED required
- Associate's or Bachelor's degree in human services, social work, or related field preferred
- 2 years of experience in healthcare/behavioral health or related field preferred
- 2 years of experience with prior authorization, insurance verification, behavioral health operations, medical billing, utilization review, or healthcare navigation preferred
- Ability to maintain confidential information
- Strong communication and organizational skills
- Proficiency with electronic health records and Microsoft Office
- Ability to work in a fast-paced environment with multiple priorities
- Understanding of Medicaid, managed care, and behavioral health authorization processes preferred
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