Summary The Prior Authorization Specialist is responsible for obtaining, tracking, and maintaining insurance authorizations for Day Treatment, Psychiatry, ABA, Speech Therapy, Occupational Therapy, and other clinical services provided by REACH. This position serves as the liaison between clinicians, insurance companies, referral sources, and families to ensure services are authorized prior to treatment and that existing authorizations are renewed without interruption. REACH Behavioral Health and its subsidiary, CJ Hendry are growing, multi-location behavioral health agencies. The combined agencies currently serve 1,500 clients at 12 locations throughout Northeast Ohio. Essential Duties and Responsibilities Prior Authorizations Obtain initial authorizations for all applicable services. Submit authorization requests through payer portals, phone, or fax. Gather and organize all required clinical documentation. Review documentation for completeness prior to submission. Track authorization status until approved. Follow up with insurance companies regarding pending requests. Coordinate peer-to-peer reviews when required. Escalate urgent authorization issues to clinical leadership. Authorization Management Maintain an accurate authorization tracking system. Monitor expiration dates and begin renewal requests before authorizations expire. Verify approved units, service dates, frequencies, and provider information. Update the EHR and billing system with authorization numbers and approved units. Notify clinical staff immediately of authorization approvals, denials, or limitations. Clinical Coordination Work closely with therapists, psychiatrists, nurse practitioners, BCBAs, speech-language pathologists, occupational therapists, and case managers. Request additional documentation when necessary to support medical necessity. Educate clinicians regarding payer documentation requirements. Assist providers in responding to payer requests for additional information. Insurance Verification Verify eligibility and benefits as needed. Identify payer-specific authorization requirements. Monitor changes in insurance coverage that may affect treatment. Communicate coverage issues to scheduling, billing, and clinical staff. Denial Management Review authorization denials. Coordinate appeals with providers. Prepare appeal documentation. Track appeal outcomes. Identify trends that contribute to authorization denials and recommend process improvements. Documentation Maintain accurate records of all payer communications. Document authorization activity in the electronic health record. Ensure compliance with payer policies and organizational procedures.

Collaboration Work closely with:

Billing Department Intake Department Scheduling Clinical Supervisors Providers Families Assist with process improvement initiatives related to authorizations and revenue cycle management. Required qualifications Medical Assistant certification or equivalent clinical experience. Minimum of two years of experience in healthcare administration, prior authorizations, insurance verification, or medical office operations. Experience working with electronic health records. Strong computer and organizational skills. Excellent written and verbal communication. Ability to manage multiple priorities and deadlines. Preferred qualifications Experience in behavioral health, psychiatry, ABA, speech therapy, occupational therapy, or pediatric healthcare. Knowledge of Medicaid, Medicare, and commercial insurance authorization processes. Experience with CareLogic or similar behavioral health EHR. Understanding of CPT, ICD-10, and payer authorization requirements. Job Schedule and Working Conditions • The job follows a year-round schedule for a total of 249 work days in a year

Job Type:

Full-time Pay:

$21.00 - $24.00 per hour

Benefits:

Dental insurance Health insurance Life insurance Paid time off Vision insurance

Work Location:

Hybrid remote in Brookpark, OH 44142