Pre Authorization Specialist

Position Summary

The Pre-Authorization Specialist is responsible for securing timely and accurate insurance authorizations for clients entering IOP and PHP services. This role ensures access to care while maintaining compliance with payer requirements and organizational standards, working closely with admissions, clinical, and billing teams to support efficient treatment initiation.

Key Responsibilities

· Obtain and manage prior authorizations for IOP/PHP services (assessments, individual, group, and family therapy).

· Verify insurance eligibility, benefits, and coordination of benefits (Medicaid, commercial, managed care).

· Collaborate with billing to resolve denials and submit appeals as needed.

· Coordinate with clinical staff to gather required documentation (assessments, treatment plans, progress notes).

· Track and document authorizations and re-authorizations in the EHR/billing system.

· Monitor authorization timelines to prevent lapses in care.

· Educate clients on insurance coverage and authorization processes.

· Stay current on payer policies and behavioral health requirements.

· Partner with admissions and clinical teams to support seamless intake.

· Route all insurer requests (e.g., clinical reviews, records) through CEO approval prior to response.

Qualifications

· High school diploma required; associate degree or higher preferred (healthcare administration or related field).

· Experience in insurance verification, pre-authorization, or medical billing (behavioral health preferred).

· Knowledge of Medicaid, commercial insurance, and managed care processes.

· Familiarity with IOP/PHP services and clinical documentation (preferred).

· Strong organizational, communication, and problem-solving skills.

· Proficiency with EHR systems, insurance portals, and Microsoft Office.

Working Conditions

· Office-based with potential hybrid flexibility.

· Frequent interaction with insurers, staff, and clients.

· Fast-paced, deadline-driven environment.

Core Competencies

· Insurance authorization expertise

· Attention to detail and accuracy

· Time management and multitasking

· Professional, empathetic communication

· Team collaboration with independent execution