Payer Authorization Specialist

• Investigate and resolve payer and agency denials.
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• Review denial reasons and coordinate corrective actions with clinical and billing staff.
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• Submit initial, concurrent, and retrospective authorization requests as required.
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• Monitor authorization expirations and obtain extensions before services lapse.
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• Track denied claims and authorizations through resolution.
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• Communicate authorization requirements and deficiencies to clinical staff.
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• Work directly with Medicaid managed care organizations and commercial insurance plans regarding authorization issues.
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• Prepare and submit reconsiderations and appeals when appropriate.
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• Maintain accurate documentation of all payer communications and authorization activity.
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• Identify denial trends and recommend process improvements to reduce future denials.
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• Assist with audits related to authorizations and payer compliance.
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• Maintain knowledge of payer guidelines, Ohio Medicaid requirements, and agency regulations.
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• Collaborate with the billing department to ensure timely claim submission and reimbursement.
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• Perform other related duties as assigned.

Qualifications/ Education/Experience Requirements

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• High school diploma or GED required; associate degree preferred.
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• One to three years of experience in medical billing, prior authorizations, insurance verification, or behavioral health preferred.
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• Experience with Medicaid managed care organizations and behavioral health billing is strongly preferred.
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• Knowledge of medical terminology, payer authorization processes, and insurance denials.
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• Strong organizational and problem-solving skills.
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• Excellent written and verbal communication skills.
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• Ability to manage multiple priorities while meeting deadlines.
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• Proficiency with electronic health records and Microsoft Office applications.

Performance Expectations

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• Maintain timely submission and follow-up of all authorization requests.
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• Minimize preventable authorization-related denials.
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• Meet departmental productivity and accuracy standards.
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• Maintain complete and accurate documentation.
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• Demonstrate professionalism, accountability, and effective communication.
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• Support continuous improvement initiatives that reduce denials and improve reimbursement