RRP Prior Authorization Specialist

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

📋 Description

• Oversee the prior authorization and intake procedures for clients entering or receiving services through the Residential Recovery Program (RRP).

• Ensure that all necessary authorizations are secured prior to admission or continuation of residential treatment services.

• Prepare, submit, and monitor initial and concurrent prior authorization requests for residential treatment services.

• Keep track of authorization expiration dates and proactively submit reauthorization requests before coverage lapses.

• Communicate with Medicaid Managed Care Organizations (MCOs), commercial insurance providers, and other payers regarding the status of authorizations.

• Maintain well-organized electronic documentation to ensure regulatory compliance, support payer audits, and facilitate internal quality reviews.

⛳️ Requirements

• High school diploma or equivalent is required.

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

• Ability to successfully complete all required background and reference checks.

• A minimum of 1–2 years of experience in healthcare prior authorizations, utilization management, admissions, intake coordination, or insurance verification.

• Experience in supporting Residential Recovery Programs (RRP), Substance Use Disorder (SUD) treatment, behavioral health, or residential treatment programs is strongly preferred.

• Familiarity with Maryland Medicaid and Managed Care Organization (MCO) authorization requirements is preferred.

• Proficiency in using Electronic Health Records (EHR), payer portals, and Microsoft Office applications is preferred.

🏝️ Benefits

• Not eligible (Independent Contractor position).