What are the responsibilities and job description for the Prior Authorization Specialist position at Radiant Health?
Are you detail-oriented, organized, and passionate about helping people access the care they need? We’re looking for a Prior Authorization Specialist to play a key role in ensuring timely access to mental health and substance use services.
In this role, you’ll work at the intersection of clinical care and insurance processes—helping patients receive necessary services while ensuring compliance with payer and regulatory requirements. Your work will directly support providers, care teams, and clients by reducing delays and preventing claim denials.
What You’ll Do
- Review clinical documentation for completeness and alignment with medical necessity criteria (e.g., InterQual or MCG Health)
- Submit prior authorization requests to Medicaid, managed care organizations, and commercial payers
- Track and follow up on authorization requests (pending, approved, or denied)
- Collaborate with clinicians to obtain required documentation or clarification
- Communicate with insurance companies to resolve authorization issues and denials
- Maintain accurate, timely records in EHR and payer systems
- Ensure compliance with HIPAA and payer-specific guidelines
- Assist with appeals and reconsiderations for denied services
- Verify patient eligibility and benefits, including Medicaid and Healthy Indiana Plan (HIP)
- Monitor authorization expiration dates and request extensions as needed
- Support audits by maintaining complete and compliant documentation
- Provide backup support for Medicaid Eligibility & Enrollment functions, as needed
- Perform other related duties within the scope of the role
If you’re ready to make an impact in a fast-paced, mission-driven environment, we encourage you to apply!
Qualifications:- High school diploma or GED required.
- Associate or bachelor’s degree in behavioral health, social work, healthcare administration, or related field preferred
- Valid driver's license, car insurance, and reliable vehicle
- Experience with prior authorization for behavioral health services, familiarity with ICD-10 and CPT coding basics and experience working with Medicaid and Managed Care Organizations preferred
- Knowledge of Insurance and billing processes preferred
- High attention to detail
- Strong data entry and computer skills
- Ability to meet with clients either in the community, in their home, or at a Radiant Health location to complete the necessary tasks as deemed necessary by supervisory staff