PRP Prior Authorization Specialist
$10,400–$11,440 year
RemotePhilippines
Job Summary
Collect and verify intake documentation for new PRP referrals, then prepare, submit, and track initial and continuing prior authorization requests for Maryland Medicaid and Managed Care Organizations. Monitor expiration dates to initiate renewals at least three business days before scheduled service delivery, while coordinating with providers to obtain missing clinical information and signatures. Update electronic health records with authorization statuses and notify clinical departments regarding approvals, denials, or delays. Maintain organized records to support audits, participate in weekly workflow meetings, and provide coverage during absences while ensuring HIPAA compliance.
Required Qualifications
- High school diploma or equivalent
- Ability to successfully complete required background and reference checks
- Minimum of 1–2 years of experience in healthcare administration, prior authorization, medical intake, or insurance verification
- Knowledge of Maryland Medicaid and Managed Care Organization (MCO) authorization processes
- Understanding of Psychiatric Rehabilitation Program (PRP) services and behavioral health 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
- Proficiency using Electronic Health Records (EHR), payer portals, Microsoft Office, and related software
- Ability to work independently while collaborating effectively with cross-functional teams
- Strong problem-solving and follow-up skills
- Commitment to confidentiality, accuracy, and regulatory compliance
- Ability to perform effectively in a fast-paced, deadline-driven remote environment
Desired Qualifications
- Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field
- Experience supporting behavioral health, Psychiatric Rehabilitation Programs (PRP), or outpatient mental health services
- Experience working with Maryland Medicaid, Managed Care Organizations (MCOs), or behavioral health payer requirements
- Experience using Electronic Health Record (EHR) systems and payer portals
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