RRP Prior Authorization Specialist

This a Philippine-based position;

NOT a US based position and the pay rate is not in US currency.

ABOUT FREEDOM HEALTH SYSTEMS, INC:

Freedom Health Systems, Inc. is a mission-driven healthcare advisory and management consulting firm that partners with behavioral health and human services organizations to improve access, equity, and operational excellence. We specialize in guiding providers through program development, accreditation, compliance, and clinical best practices—empowering them to deliver high-quality, person-centered care to their communities.

While we do not provide direct healthcare services, Freedom Health Systems plays a vital role behind the scenes by strengthening organizational infrastructure, supporting service expansion, and helping our partners lead with innovation and integrity. Our expertise spans a wide range of operational services, including revenue cycle management, prior authorization, virtual front office support, medical billing and coding, human resources, and compliance consulting.

At Freedom Health Systems, we are deeply committed to breaking down barriers in the behavioral health space, with a particular focus on serving marginalized and underserved populations. Our team fosters a collaborative, forward-thinking work environment where every employee contributes to advancing impactful, community-based care.

DISCLOSURES:

The specific statements shown in each section of this job description are not intended to be all-inclusive. They represent typical elements and criteria considered necessary to perform the job successfully. The job’s responsibilities/tasks may be modified and/or expanded over time. Company will inform the personnel member when changes in the respective job description are made.

COMPANY WEBSITE: https://freedomhs.org 

COMPANY PHONE NUMBER:  667-239-9572

HUMAN RESOURCES DEPARTMENT PHONE NUMBER:  667-239-9572 EXT 10

HUMAN RESOURCES DEPARTMENT EMAIL ADDRESS:  info@freedomhs.org 

POSITION TITLE: RRP Prior Authorization Specialist - Residential Recovery Program

ALTERNATE TITLE(S): Residential Recovery Prior Authorization Coordinator, Authorization & Intake Coordinator, Utilization Management Coordinator

COMPANY: Freedom Health Systems, Inc. (in support of all customer companies under contract)

DIVISION: Accounting & Finance

DEPARTMENT: Accounts Receivables

UNIT: Prior Authorization

BENEFITS PACKAGE: Ineligible.

WORK SCHEDULE: Monday – Friday, 8:00 AM EST – 5:00 PM EST

ACCOUNTABLE TO: Prior Authorization Unit Supervisor (Accounts Receivables Department Manager in the absence of the Prior Authorization Unit Supervisor)

ACCOUNTABLE FOR:  Timely and accurate submission of authorization requests and intake coordination for Residential Recovery Program (RRP) clients.

CLASSIFICATION: W8BEN

COMPENSATION RANGE: ₱340.35 PHP per hour (this is not USD)

ANTICIPATED TRAVEL: none

SUMMARY OF POSITION RESPONSIBILITIES: This role ensures that all clients receive the required authorization before admission or continuation of Residential Recovery Program services, helping prevent delays in treatment, ensuring regulatory compliance, and maximizing reimbursement opportunities.

• Collect and verify intake documentation for new clients referred to the Residential Recovery Program (RRP).
• Review insurance eligibility, payer requirements, and authorization guidelines for each referral.
• Prepare, submit, and track initial and concurrent prior authorization requests for Residential Recovery Program services.
• Monitor authorization expiration dates and proactively submit reauthorization requests before coverage lapses.
• Coordinate with clinical staff to obtain assessments, treatment plans, physician orders, and other supporting documentation required by payers.
• Communicate with Medicaid Managed Care Organizations (MCOs), commercial insurance carriers, and other payers regarding authorization status.
• Update the Electronic Health Record (EHR) and internal authorization tracking systems with current authorization information.
• Ensure all authorization requests are completed within established timelines to prevent interruptions in residential services.
• Notify admissions, clinical, billing, and program staff of authorization approvals, denials, or requests for additional information.
• Maintain complete and organized electronic documentation for regulatory compliance, payer audits, and internal quality reviews.
• Assist with client admissions by coordinating authorization-related requirements prior to admission.
• Escalate authorization denials or urgent cases to the appropriate clinical or supervisory staff for timely resolution.

UNSCHEDULED DUTIES AND RESPONSIBILITIES:

• Assist your supervisor with work-related assignments and special projects as requested.
• Remain informed and compliant with applicable regulations, including COMAR, CARF, Medicaid requirements, and company policies.
• Participate in quality assurance, utilization management, and performance improvement initiatives.
• Maintain confidentiality of all client, financial, and organizational information in accordance with HIPAA and company policies.
• Participate in internal and external audits, including CARF, CSA, OHCQ, Medicaid, and payer reviews.
• Assist with insurance eligibility verification and benefit reviews during periods of high referral volume.
• Participate in weekly authorization, admissions, and interdisciplinary team meetings.
• Cross-train and provide coverage for other authorization specialists as needed.
• Support appeals, reconsiderations, and peer-to-peer review coordination for denied authorization requests.
• Assist in developing and maintaining authorization workflows, documentation standards, and performance metrics.
• Support data collection and reporting related to authorization turnaround times, denial rates, payer trends, and compliance initiatives.
  
  

WORKING CONDITIONS:

• Remote (Philippines-based position supporting U.S. operations)
• Fast-paced, deadline-driven environment with frequent interaction with U.S.-based clinical, billing, and admissions teams
• Requires availability during U.S. Eastern Standard Time (EST) business hours
  
  

COMPETENCIES AND SKILLS:

• Knowledge of Maryland Medicaid, Managed Care Organizations (MCOs), and behavioral health authorization requirements.
• Understanding of Residential Recovery Program (RRP), substance use disorder (SUD), behavioral health, and residential treatment terminology.
• Strong knowledge of prior authorization, utilization management, and medical necessity documentation.
• Excellent organizational skills with the ability to manage multiple concurrent authorization requests.
• Strong attention to detail and follow-through.
• Excellent written and verbal communication skills.
• Ability to work independently while collaborating with multidisciplinary teams.
• Experience navigating Electronic Health Records (EHRs), payer portals, and Microsoft Office applications.
• Ability to analyze payer requirements and resolve authorization issues efficiently.

LEVEL OF EDUCATION / TRAINING / QUALIFICATIONS:

• High school diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Health Information Management, or a related field preferred.
• Minimum of 1–2 years of experience in healthcare prior authorizations, utilization management, admissions, intake coordination, or medical insurance verification.
• Experience supporting Residential Recovery Programs (RRP), Substance Use Disorder (SUD) treatment, behavioral health, residential treatment facilities, or similar healthcare settings strongly preferred.
• Working knowledge of Maryland Medicaid and Managed Care Organization (MCO) authorization requirements preferred.
• Experience using Electronic Health Records (EHR), payer portals, and Microsoft Office applications.
• Ability to pass background and reference checks.