OMHC Prior Authorization Specialist
New
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Enterprise Management Solutions, LLCHealthcare Administration
Remote (Philippines), Monday through Friday, 8:00 AM – 5:00 PM Eastern Time (U.S.)ContractMiddle
Salary4.5 - 5 USD per hour
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Job Details
- Experience
- 1-2 years
- Required Skills
- Microsoft OfficeGoogle WorkspaceEHR
Requirements
- High school diploma or equivalent required.
- Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.
- Minimum of one (1) to two (2) years of experience in healthcare administration, medical prior authorizations, insurance verification, or patient intake coordination.
- Experience with outpatient mental health (OMHC), behavioral health, psychiatric rehabilitation (PRP), or primary care authorizations preferred.
- Experience working with Maryland Medicaid, Managed Care Organizations (MCOs), or commercial insurance authorization processes preferred.
- Experience using electronic health record (EHR) systems and payer portals is highly desirable.
- Ability to successfully complete required background and reference checks.
Responsibilities
- Collect, review, and verify intake documentation for new client referrals.
- Review insurance eligibility, benefits, and payer-specific authorization requirements.
- Prepare, submit, and track initial and continuing prior authorization requests.
- Monitor authorization status and proactively follow up with payers to ensure timely approvals.
- Initiate renewal requests before authorization expiration dates to prevent service interruptions.
- Communicate with providers and clinical staff to obtain missing documentation, signatures, or clinical information.
- Update electronic health records (EHRs), payer portals, and internal tracking systems with authorization status.
- Ensure all authorization requirements are completed at least three (3) business days prior to scheduled services whenever possible.
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