Behavioral Health PA Specialist: Payer & Denials Expert

South Coast Community Services; San Bernardino (CA); On-site; USD 52,000 - 70,000; Full time

Job summary

South Coast Community Services in California seeks a Behavioral Health Authorizations Specialist to manage the full prior authorization lifecycle across commercial, Medi-Cal, and managed care payers. You will ensure timely approvals, coordinate with clinical teams, and minimize gaps in care.

The role requires thorough knowledge of payer requirements, strong follow-up, accurate documentation in MyEvolve, and proactive denial management, with close collaboration to intake, billing, and

Qualifications

• Experience with PA workflows for behavioral health outpatient services.
• Ability to coordinate with clinical staff for documentation.
• Knowledge of Medi-Cal and commercial payer requirements.

Responsibilities

• Initiate and track PA requests across payer mix.
• Verify complete clinical and demographic information.
• Monitor open authorizations and follow up before approvals.
• Manage continued stay reviews to prevent gaps.
• Draft and track appeals for denials.
• Maintain authorization logs and reports.

Skills

PA requirements

Payer portals

Documentation accuracy

Communication skills

HIPAA knowledge

Education

Bachelor's degree

Tools

Availity

Navinet

MyEvolve

Job description

South Coast Community Services in California seeks a Behavioral Health Authorizations Specialist to manage the full prior authorization lifecycle across commercial, Medi-Cal, and managed care payers. You will ensure timely approvals, coordinate with clinical teams, and minimize gaps in care.

The role requires thorough knowledge of payer requirements, strong follow-up, accurate documentation in MyEvolve, and proactive denial management, with close collaboration to intake, billing, and