Prior Authorization Specialist

Job DescriptionJob DescriptionWe are seeking a Prior Authorization Specialist!Southeastern, OH (virtual position) Integrated Services for Behavioral Health (ISBH) is a community-minded, forward-thinking behavioral health organization helping people along the road to health and well-being. We meet people in their homes and communities and help connect them to the resources they need. We serve Southeastern and Central Ohio with a comprehensive array of behavioral health and other services, working with local partners to promote healthy people and strong communities.

All of our services are intended to be collaborative and personalized for the individual.The Prior Authorization Specialist serves as the lead staff member for prior authorizations within Integrated Services for Behavioral Health. This role supports timely access to behavioral health and substance use treatment services by coordinating insurance approvals, resolving coverage barriers, monitoring authorization requirements, and collaborating closely with clinical, intake, billing, and care coordination teams.The salary for this position is $19.00-$22.26 an hour, based on experience. Essential Functions:Lead the prior authorization process for outpatient behavioral health, substance use disorder, intensive outpatient, and other covered services, including submissions, extensions, and continued stay reviewsCoordinate with providers and clinical teams to obtain and submit required documentation supporting medical necessity and authorization requestsMonitor authorization timelines, approved units, and expiration dates to prevent service interruptions and potential denied claimsCommunicate authorization approvals, denials, and follow-up needs to clinical, billing, and operational staffAssist with appeals, reconsiderations, peer reviews, and the resolution of denied or delayed servicesVerify insurance eligibility, behavioral health benefits, and service coverage across Medicaid, managed care, commercial insurance, and OhioRISE plansSupport coordination of coverage changes, payer transitions, Medicaid enrollment issues, and secondary insurance concerns.Serve as a liaison between clinical staff, billing teams, insurance companies, and external partners regarding authorization and coverage issuesDevelop and improve workflows, tracking systems, and communication processes related to authorizations and insurance navigationMonitor authorization trends, payer requirements, denials, and operational barriers while participating in interdisciplinary meetings and process improvement initiativesUtilize databases and Electronic Health Record systems for accurate client information retrievalMaintain compliance with HIPAA, mandated reporting requirements, and professional ethical guidelinesOther duties as assignedMinimum RequirementsEducation:A high school diploma or GED is requiredAn associate's or bachelor's degree in human services, social work, or a related field is preferredExperience:2 years of experience in healthcare, behavioral health, or a related field is preferred2 years of experience working with prior authorization, insurance verification, behavioral health operations, medical billing, utilization review, or healthcare navigation is preferredExperience working within community mental health, substance use treatment, healthcare, or social service settings is preferredKnowledge, Skills, and Abilities:Advanced communication skills, both oral and written is requiredAdvanced organizational skills are requiredProblem-solving and customer service skills are requiredThe ability to maintain confidential information is requiredKnowledge of Medicaid, managed care, commercial insurance, OhioRISE, waiver services, and behavioral health authorization processes is preferredThe ability to manage multiple priorities and maintain attention to detail in a fast-paced environment is required Proficiency with electronic health records and Microsoft Office applications is requiredAbility to manage deadlines within a fast-paced, high-volume environment is requiredThe ability to operate in an Internet-based, automated office environment is requiredThe ability to maintain a high-speed internet connection is requiredPhysical Requirements:Prolonged periods of sitting at a desk and working on a computer are requiredMust be able to lift up to 15 pounds at timesEnjoy a great work environment with an excellent salary, generous paid time off, and a strong benefits package.Benefits include:MedicalDentalVisionShort-term DisabilityLong-term Disability401K w/ Employer MatchEmployee Assistance Program (EAP) provides support and resources to help you and your family with a range of issues.To learn more about our organization: https://ISBH.org/OUR MISSION Delivering exceptional care through connectionOUR VALUES Dignity - We meet people where they are on their journey with respect and hopeCollaboration - We listen to understand and ask how we can best support the people and communities we serveWellbeing - We celebrate one another's strengths, and we support one another in being wellExcellence - We demand high-quality care for those we serve, and are a leader in how we care for one another as a teamInnovation - We deeply value a range of perspectives and experiences, knowing it is what inspires us to stretch past where we are and reach towards what we know is possible"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this position.

It is not to be construed as an exhaustive list of duties performed by the individuals in this role, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision.”We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.