RRP Prior Authorization Specialist
$10,400–$11,440 year
RemotePhilippines
Job Summary
Coordinate prior authorizations and intake documentation for clients entering the Residential Recovery Program by verifying insurance eligibility, preparing submission requests, and tracking expiration dates. Submit requests to Medicaid Managed Care Organizations, commercial insurers, and other payers while monitoring status, renewals, and denials. Collaborate with admissions, clinical, and billing teams to obtain assessments, treatment plans, and physician orders, then update Electronic Health Records and internal tracking systems. Escalate urgent cases or complex payer issues to supervisory staff and support appeals and peer-to-peer reviews. Ensure all activities comply with Maryland Medicaid, COMAR, CARF, and HIPAA regulations while maintaining organized electronic documentation for audits.
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 prior authorizations, utilization management, admissions, intake coordination, or insurance verification
Desired Qualifications
- Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Health Information Management, or a related field
- Experience supporting Residential Recovery Programs (RRP), Substance Use Disorder (SUD) treatment, behavioral health, or residential treatment programs
- Working knowledge of Maryland Medicaid and Managed Care Organization (MCO) authorization requirements
- Experience using Electronic Health Records (EHR), payer portals, and Microsoft Office applications
- Knowledge of Maryland Medicaid, Managed Care Organizations (MCO), and behavioral health authorization processes
- Understanding of Residential Recovery Programs (RRP), Substance Use Disorder (SUD), behavioral health, and residential treatment terminology
- Strong knowledge of prior authorization, utilization management, and medical necessity documentation
- Excellent organizational and time management skills
- Strong attention to detail and ability to manage multiple concurrent authorization requests
- Excellent written and verbal communication skills
- Strong analytical and problem-solving abilities
- Proficiency with Electronic Health Records (EHR), payer portals, Microsoft Office, and related software
- Ability to work independently while collaborating effectively with multidisciplinary teams
- Commitment to confidentiality, regulatory compliance, and continuous quality improvement
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