Behavioral Health Authorization Lead - Remote

Revive Bhs Llc; Severna Park (MD); Hybride; USD 70 000 - 95 000; Plein temps

Avantages offerts par ce poste

401(k) matching

Dental insurance

Health insurance

Paid time off

Résumé du poste

Revive BHS is seeking an experienced Insurance Authorization Supervisor to oversee our verification and authorization operations. Lead the team to ensure timely initial and concurrent authorizations, maintain payer compliance, and support efficient reimbursement for behavioral health clients.

The role requires deep knowledge of behavioral health authorizations, including residential, PHP, IOP, and outpatient services, with strong leadership skills and the ability to coordinate across multiple

Qualifications

• Minimum of 3 years of experience in insurance authorizations, utilization management coordination, or revenue cycle management within the behavioral health industry.
• Previous supervisory, team lead, or management experience.
• Strong working knowledge of substance use disorder and mental health treatment services, including residential, PHP, IOP, and outpatient levels of care.
• Experience working with commercial insurance carriers, Medicaid, and Medicaid managed care organizations.
• Demonstrated experience managing initial and concurrent authorization requests, tracking approved units, and resolving authorization denials.
• Familiarity with medical necessity criteria, including ASAM Criteria and payer-specific utilization management guidelines.
• Proficiency with insurance payer portals, EHR systems, and authorization tracking tools.
• Strong organizational, analytical, communication, and problem-solving skills.
• Ability to manage competing priorities, meet strict deadlines, and oversee multiple client accounts.

Responsabilités

• Supervise, train, and support insurance authorization and verification specialists.
• Manage daily workloads, staff assignments, productivity, and overall team performance.
• Establish and maintain standardized authorization procedures and workflows.
• Monitor staff performance, identify training opportunities, and provide ongoing coaching.
• Serve as the primary escalation point for complex authorization issues, payer disputes, and urgent requests.
• Ensure consistent communication and coordination between authorization specialists, billing teams, and client organizations.
• Oversee the timely submission, tracking, and follow-up of initial, concurrent, and continued-stay authorization requests.
• Ensure authorizations are obtained and maintained for applicable behavioral health services, including residential treatment, PHP, IOP, and outpatient services.
• Monitor authorization expiration dates, approved units, service limitations, and continued-stay requirements to prevent gaps in coverage.
• Review authorization requests for accuracy, completeness, and compliance with payer-specific requirements.
• Coordinate with clinical teams to obtain supporting documentation, medical necessity information, and other materials required for authorization.
• Manage authorization denials, reconsiderations, appeals, and peer-to-peer review coordination.
• Identify and resolve authorization barriers that could delay treatment or reimbursement.
• Maintain familiarity with payer-specific authorization requirements, submission platforms, and clinical review processes.
• Oversee insurance verification and benefits investigation processes to ensure accurate identification of patient coverage.
• Ensure verification of eligibility, behavioral health benefits, authorization requirements, deductibles, copayments, coinsurance, and applicable coverage limitations.
• Identify potential coverage issues, out-of-network restrictions, and payer-specific reimbursement concerns.
• Ensure accurate documentation of verification findings and communication of financial responsibility information to appropriate teams.
• Collaborate with billing and collections teams to identify and resolve authorization-related claim denials.
• Monitor authorization-related denial trends and implement corrective action plans.
• Conduct routine quality assurance reviews of authorization records, documentation, and staff performance.
• Develop and maintain tracking systems and reports for authorization status, turnaround times, denials, and outstanding requests.
• Ensure accurate and timely documentation within electronic health record (EHR) systems, payer portals, and internal tracking platforms.
• Identify opportunities to improve workflows, reduce administrative delays, and increase operational efficiency.
• Maintain compliance with HIPAA, payer requirements, and applicable federal and state regulations.

Connaissances

Organizational skills

Analytical skills

Communication skills

Problem-solving

Outils

EHR systems

Payer portals

Description du poste

Revive BHS is seeking an experienced Insurance Authorization Supervisor to oversee our verification and authorization operations. Lead the team to ensure timely initial and concurrent authorizations, maintain payer compliance, and support efficient reimbursement for behavioral health clients.

The role requires deep knowledge of behavioral health authorizations, including residential, PHP, IOP, and outpatient services, with strong leadership skills and the ability to coordinate across multiple