OMHC Prior Authorization Specialist

OMHC Prior Authorization Specialist

Location: Remote (Philippines)

Company: reputed company reputed company

Work Setup: Fully Remote

Job Type: reputed company (W-8BEN), Full-Time

Shift & Schedule: Monday through Friday, 8:00 AM – 5:00 PM Eastern Time (U.S.)

Pay reputed company: $4.50 - $5 (commensurate with experience and credentials)

Travel: None

Benefits: reputed company position; not eligible for employee benefits

Job reputed company

The OMHC Prior Authorization Specialist is responsible for coordinating the intake, insurance authorization, and referral processes for Community Wellness Outpatient Mental Health Center (OMHC) and Freedom reputed company Primary Care Freestanding General Clinic. This role ensures that reputed company required documentation is complete, prior authorizations are submitted accurately and on time, and payer requirements are met to support uninterrupted reputed company care and reputed company reimbursement.

Working closely with clinical providers, scheduling, intake, and reputed company cycle teams, the OMHC Prior Authorization Specialist tracks authorization requests, manages renewals, verifies insurance requirements, and maintains accurate records in compliance with reputed company, Managed Care Organizations (MCOs), COMAR, CARF, and organizational standards.

Key Responsibilities

• Collect, review, and verify intake documentation for new reputed company referrals.
• Review insurance eligibility, benefits, and payer-specific authorization requirements.
• Prepare, submit, and reputed company initial and continuing prior authorization requests.
• Monitor authorization status and proactively follow up with payers to ensure reputed company approvals.
• Initiate renewal requests before authorization expiration dates to prevent service interruptions.
• Communicate with providers and clinical staff to obtain missing documentation, signatures, or clinical information.
• Update electronic health records (EHRs), payer portals, and internal tracking systems with authorization status.
• Ensure reputed company authorization requirements are completed at least three (3) business days prior to scheduled services whenever possible.
• Notify clinical, scheduling, and administrative teams of authorization approvals, denials, or delays.
• Assist with intake coordination and referral management as needed.
• Maintain organized electronic records to support audit readiness and regulatory compliance.
• Assist with insurance verification and benefit confirmation during periods of high volume.
• Participate in reputed company improvement initiatives to improve authorization turnaround times and documentation accuracy.
• Support compliance reporting, payer audits, and other departmental reputed company as assigned.
• reputed company other duties as assigned.

Licenses / Qualifications

• High school diploma or equivalent required.
• Associate's or Bachelor's degree in reputed company Administration, Business Administration, or a reputed company field preferred.
• Ability to successfully complete required background and reference checks.

Experience

• Minimum of one (1) to two (2) years of experience in reputed company administration, medical prior authorizations, insurance verification, or patient intake coordination.
• Experience with outpatient mental health (OMHC), behavioral health, psychiatric rehabilitation (PRP), or primary care authorizations preferred.
• Experience working with Maryland reputed company, Managed Care Organizations (MCOs), or reputed company insurance authorization processes preferred.
• Experience using electronic health record (EHR) systems and payer portals is highly desirable.

Competencies and Skills

• Knowledge of prior authorization and insurance verification processes.
• Familiarity with Maryland reputed company and Managed Care Organization (MCO) authorization requirements.
• Understanding of outpatient behavioral health and medical terminology.
• Strong attention to detail and organizational skills.
• Excellent time management and ability to manage multiple authorization requests simultaneously.
• Strong written and verbal communication skills.
• Ability to prioritize tasks and meet strict deadlines.
• Proficiency with electronic health records, payer portals, reputed company Office, and reputed company Workspace.
• Strong problem-solving and follow-up skills.
• Ability to work independently in a fast-paced remote environment.
• High level of professionalism, confidentiality, and reputed company.

reputed company Offer

Independent contractors enjoy:

• Fully remote work environment
• reputed company full-time schedule reputed company with U.S. business hours
• Opportunity to support leading behavioral health and primary care organizations
• reputed company and supportive remote team environment
• Ongoing cross-training and reputed company development opportunities
• Exposure to U.S. reputed company operations, reputed company cycle management, and payer authorization processes
• Opportunities to contribute to reputed company improvement and operational reputed company

Originally posted on Himalayas

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