Prior Authorization Specialist
$39,520–$46,301 year
Remote
Job Summary
Lead the prior authorization process for outpatient behavioral health and related services, coordinating documentation, monitoring timelines, communicating approvals/denials to clinical and billing teams, assisting with appeals, and ensuring HIPAA-compliant authorization workflows. Requires collaboration across clinical, intake, billing, and care coordination teams; healthcare navigation and insurance verification experience; strong communication and organizational skills; familiarity with Medicaid, OhioRISE, and various payer requirements.
Required Qualifications
- A high school diploma or GED is required
- An associate's or bachelor's degree in human services, social work, or a related field is preferred
- 2 years of experience in healthcare, behavioral health, or a related field is preferred
- 2 years of experience working with prior authorization, insurance verification, behavioral health operations, medical billing, utilization review, or healthcare navigation is preferred
- Experience working within community mental health, substance use treatment, healthcare, or social service settings is preferred
- Advanced communication skills (oral and written)
- Advanced organizational skills
- Problem-solving and customer service skills
- Ability to maintain confidential information
- Knowledge of Medicaid, managed care, commercial insurance, OhioRISE, waiver services, and behavioral health authorization processes is preferred
- Ability to manage multiple priorities in a fast-paced environment
- Proficiency with electronic health records and Microsoft Office applications
- Ability to operate in an Internet-based, automated office environment
- Must maintain a high-speed internet connection
- Prolonged periods of sitting and computer work
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