Prior Authorization Specialist

Job Summary:

Reporting to the Clinical Director and working closely with the Clinical Team, this role plays a key part in ensuring the financial health of the organization. The position serves as a vital link between patients with mental health and/or substance use disorders and insurance providers, healthcare services, and billing operations. It is essential to the success of the companys programs.

Key Responsibilities:

Therapy/IOP Prior Authorizations (PARs):

• • Confirm insurance coverage
  • Monitor and track therapy sessions weekly
  • Coordinate with therapists to obtain necessary documentation
  • Prepare and submit PARs
  • Upload and organize submissions; maintain tracking sheets
  • Notify RMH Manager and therapists of authorization outcomes
    
  Residential Mental Health (RMH) PARs:
  
  • Verify insurance eligibility
  • Complete and submit RMH PARs
  • Upload and organize documentation
  • Communicate approval or denial status to RMH Manager and therapists
    
  Housing PARs (if applicable):
  
  • Monitor the housing PAR request tracker
  • Collaborate with therapists to write clinical snapshots
  • Ensure accuracy of the tracker
  • Inform the housing team of approved applicants

Qualifications:

• Bachelor's degree required
• With at least 1 year experience in Prior Authorization.

General Duties:

• Respond promptly to emails and phone calls
• Provide timely updates to third-party payers
• Complete daily documentation
• Submit Superbills within 24 hours of patient discharge
• Attend all required meetings
• Support the Clinical Director, RMH Manager, and Therapy Team as needed