Prior Authorization Specialist

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Gather, assess, and validate intake documentation for new PRP referrals.

• Analyze payer guidelines and authorization timelines for Maryland Medicaid and Managed Care Organizations (MCOs).

• Prepare, submit, oversee, and track both initial and ongoing prior authorization requests.

• Keep an eye on authorization expiration dates and proactively start renewal requests.

• Collaborate with providers and clinical staff to acquire any missing documentation, signatures, or supporting clinical information.

• Update electronic health records (EHR) and internal tracking systems with the current authorization status and necessary follow-up actions.

• Ensure that all authorization requirements are fulfilled at least three (3) business days before scheduled service delivery.

• Inform scheduling and clinical departments about authorization approvals, denials, delays, or pending requests.

• Assist with intake coordination and respond to referral inquiries as assigned.

• Maintain orderly electronic authorization records to facilitate audits and ensure regulatory compliance.

• Aid in verifying insurance eligibility and conducting benefit reviews during peak periods.

• Participate in weekly authorization meetings, cross-training sessions, and initiatives aimed at workflow improvement.

• Assist with quality assurance activities, payer audits, compliance evaluations, and performance enhancement projects.

• Provide coverage for fellow authorization team members during their absences or when operational needs arise.

• Uphold the confidentiality of client and organizational information in line with HIPAA regulations and company policies.

⛳️ Requirements

• High school diploma or equivalent is required.

• An Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field is preferred.

• Ability to successfully undergo required background and reference checks.

• A minimum of 1–2 years of experience in healthcare administration, prior authorization, medical intake, or insurance verification.

• Experience in supporting behavioral health, Psychiatric Rehabilitation Programs (PRP), or outpatient mental health services is preferred.

• Familiarity with Maryland Medicaid, Managed Care Organizations (MCOs), or behavioral health payer requirements is preferred.

• Proficient in using Electronic Health Record (EHR) systems and payer portals is preferred.

🏝️ Benefits

• Not eligible (Independent Contractor position).