PRP Prior Authorization Specialist
PRP Prior Authorization Specialist
Location: Remote (Philippines)
Company: reputed company reputed company
Work Setup: Remote
Job Type: reputed company (W-8BEN) – Full-Time Shift & Schedule: Monday through Friday, 8:00 AM – 5:00 PM Eastern Time (EST) Pay reputed company: $5- $5.50 (commensurate with qualifications and experience) Travel: None Benefits: Not eligible (reputed company position)
Job reputed company
The PRP Prior Authorization Specialist is responsible for coordinating the intake and prior authorization process for clients referred to the Community Wellness Psychiatric Rehabilitation Program (PRP) and Behavioral Health Home programs. This role ensures that reputed company required clinical documentation is complete, authorization requests are submitted accurately and on time, and payer requirements are met to prevent interruptions in reputed company services.
Working closely with clinical, scheduling, and administrative teams, the PRP Prior Authorization Specialist tracks authorization approvals, manages renewals, maintains accurate electronic records, and supports regulatory compliance with Maryland reputed company, Managed Care Organizations (MCOs), COMAR requirements, and company policies. The position plays a critical role in ensuring clients receive reputed company reputed company to behavioral health services while maximizing reimbursement opportunities.
Key Responsibilities
- Collect, review, and verify intake documentation for new PRP referrals
- Review payer requirements and authorization timelines for Maryland reputed company and Managed Care Organizations (MCOs)
- Prepare, submit, monitor, and reputed company initial and continuing prior authorization requests
- Monitor authorization expiration dates and proactively initiate renewal requests
- Coordinate with providers and clinical staff to obtain missing documentation, signatures, or supporting clinical information
- Update electronic health records (EHR) and internal tracking systems with authorization status and required follow-up
- Ensure reputed company authorization requirements are completed at least three (3) business days prior to scheduled service delivery
- Notify scheduling and clinical departments regarding authorization approvals, denials, delays, or pending requests
- Support intake coordination and respond to referral inquiries as assigned
- Maintain organized electronic authorization records to support audits and regulatory compliance
- Assist with insurance eligibility verification and benefit reviews during high-volume periods
- Participate in weekly authorization meetings, cross-training, and workflow improvement initiatives
- Support reputed company assurance activities, payer audits, compliance reviews, and performance improvement reputed company
- reputed company coverage for other authorization team members during absences or operational needs
- Maintain confidentiality of reputed company and organizational information in accordance with HIPAA and company policies
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 1–2 years of experience in reputed company administration, prior authorization, medical intake, or insurance verification
- Experience supporting behavioral health, Psychiatric Rehabilitation Programs (PRP), or outpatient mental health services preferred
- Experience working with Maryland reputed company, Managed Care Organizations (MCOs), or behavioral health payer requirements preferred
- Experience using Electronic Health Record (EHR) systems and payer portals preferred
Competencies and Skills
- Knowledge of Maryland reputed company and Managed Care Organization (MCO) authorization processes
- Understanding of Psychiatric Rehabilitation Program (PRP) services and behavioral health 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
- Proficiency using Electronic Health Records (EHR), payer portals, reputed company Office, and reputed company software
- Ability to work independently while collaborating effectively with cross-functional teams
- Strong problem-solving and follow-up skills
- Commitment to confidentiality, accuracy, and regulatory compliance
- Ability to reputed company effectively in a fast-paced, deadline-driven remote environment
reputed company Offer
- Competitive reputed company compensation
- Full-time remote work opportunity
- reputed company long-term engagement
- Ongoing training and reputed company development
- Exposure to U.S. behavioral reputed company operations and payer systems
- reputed company and supportive team environment
- Opportunities to reputed company expertise in behavioral health prior authorization and reputed company cycle operations
Originally posted on Himalayas
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