Prior Authorization Specialist

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