Company Overview Portage Path Behavioral Health is a non-profit community mental health center dedicated to supporting individuals with low and moderate incomes in their recovery from mental health and substance use challenges. As an affiliate of the local Mental Health and Addiction Services Board, we provide comprehensive, individualized care aimed at promoting sustained recovery and improving overall community well-being. Job Overview We are seeking an organized, detail-oriented Utilization & Benefits Specialist to join our Revenue Cycle team. This position plays an important role in helping clients access and maintain behavioral health and substance use disorder services by coordinating insurance authorizations, monitoring service utilization, and assisting clients with Medicaid enrollment and benefits. This position reports directly to the Director of Revenue Cycle Management. This is an on-site, client-facing position that works closely with clients, clinical staff, insurance companies, Medicaid managed care organizations, and other members of the Revenue Cycle team. This position may travel to all Portage Path Clinics. Responsibilities Coordinate prior authorizations and reauthorizations for behavioral health and SUD services. Monitor authorized services, units, visits, expiration dates, and payer service limitations. Proactively identify clients approaching authorization or benefit limits and coordinate necessary follow-up. Communicate with clients and treatment teams regarding authorization requirements, insurance coverage, and service limitations. Work with clinical staff to obtain documentation needed to support authorization requests. Follow up with insurance companies and Medicaid managed care organizations regarding pending, denied, or incomplete authorizations. Meet directly with clients to assist with Medicaid applications, enrollment, renewals, redeterminations, and eligibility issues. Help clients understand Medicaid and insurance correspondence, benefit requirements, and actions needed to maintain coverage. Monitor Medicaid eligibility and assist with resolving coverage gaps or terminations. Verify insurance eligibility and benefit information as needed. Help identify and prevent authorization- and eligibility-related billing denials. Maintain accurate documentation of authorizations, eligibility, benefit information, and payer communications. Collaborate with the Revenue Cycle and clinical teams to resolve issues affecting client access, coverage, billing, or reimbursement. Revenue Cycle Team Support This position is part of an integrated Revenue Cycle team and will be cross trained to provide support and coverage in other areas as needed, including: Client Registration Intake Scheduling Medical Billing Insurance eligibility and benefit verification Claim and denial research Other Revenue Cycle projects and responsibilities as assigned. Qualifications Proven experience working with behavioral health settings preferred. Strong knowledge of medical coding systems such as CPT, ICD-9, ICD-10, and familiarity with medical terminology. Experience working with Medicaid regulations and understanding of health insurance policies related to mental health services. Proficiency in electronic health records (EHR) management systems along with data entry accuracy. Demonstrated ability to work effectively while maintaining patient confidentiality under HIPAA guidelines. Strong organizational skills combined with the ability to prioritize tasks efficiently in a fast-paced environment. Requirements High school diploma or equivalent required Previous experience in healthcare, behavioral health, medical billing, insurance verification, prior authorization, Medicaid eligibility, client registration, or a related area. Knowledge of health insurance, Medicaid, managed care, prior authorization, and benefit eligibility processes. Ohio Medicaid and behavioral health experience strongly preferred. Strong organizational skills and attention to detail. Ability to manage multiple deadlines and follow-up requirements. Strong communication and problem-solving skills. Comfortable meeting directly with clients and explaining insurance, Medicaid, and service limitations in an understandable and compassionate manner. Ability to work collaboratively with clinical and Revenue Cycle staff. Experience with electronic health records and insurance payer portals preferred. Reliable transportation is required to travel between clinics.

Benefits:

403(b) Dental insurance Disability insurance Employee assistance program Health insurance Paid sick time Paid time off Retirement plan Vision insurance

Work Location:

In person