PRP Prior Authorization Specialist

PRP Prior Authorization Specialist

Location: Remote (Philippines)
Company: Enterprise Management Solutions, LLC
Work Setup: Remote
Job Type: Independent Contractor (W-8BEN) – Full-Time
Shift & Schedule: Monday through Friday, 8:00 AM – 5:00 PM Eastern Time (EST)
Pay Rate: $5- $5.50 (commensurate with qualifications and experience)
Travel: None
Benefits: Not eligible (Independent Contractor position)

Job Description

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 all required clinical documentation is complete, authorization requests are submitted accurately and on time, and payer requirements are met to prevent interruptions in client 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 Medicaid, Managed Care Organizations (MCOs), COMAR requirements, and company policies. The position plays a critical role in ensuring clients receive timely access 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 Medicaid and Managed Care Organizations (MCOs)
• Prepare, submit, monitor, and track 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 all 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 quality assurance activities, payer audits, compliance reviews, and performance improvement projects
• Provide coverage for other authorization team members during absences or operational needs
• Maintain confidentiality of client 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 Healthcare Administration, Business Administration, or a related field preferred
• Ability to successfully complete required background and reference checks

Experience

• Minimum of 1–2 years of experience in healthcare 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 Medicaid, 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 Medicaid 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, Microsoft Office, and related 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 perform effectively in a fast-paced, deadline-driven remote environment

What We Offer

• Competitive hourly compensation
• Full-time remote work opportunity
• Stable long-term engagement
• Ongoing training and professional development
• Exposure to U.S. behavioral healthcare operations and payer systems
• Collaborative and supportive team environment
• Opportunities to develop expertise in behavioral health prior authorization and revenue cycle operations