Behavioral Health Prior Authorization & Billing Specialist

Kids for the Future; Toledo (OH); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Competitive Pay + 401(k) with Employer

Generous Paid Time Off

Tuition Reimbursement

Comprehensive Medical, Dental & Vision

Employee Assistance Program

Job summary

Team Recovery is seeking a Prior Authorization Specialist to manage pre-authorization processes for behavioral health and addiction recovery services. You will work with providers, insurers, and clients to ensure timely submissions and regulatory compliance.

The role requires 3+ years in credentialing, prior-authorization, and insurance reimbursement, with preference for behavioral health experience. Strong communication, multitasking, and EMR proficiency are essential for success.

Qualifications

• High School Diploma or GED required.
• Associates or bachelor's degree in healthcare administration preferred.
• 3+ years of experience in credentialing, prior-authorization, and insurance reimbursement preferred.
• Experience in Behavioral Health and SUD treatment field preferred.
• Ability to read and interpret written information; write clearly and informatively; edit for spelling and grammar.
• Clear, persuasive communication; ability to participate in meetings and present to groups.
• Proficient with billing software and EMR systems.
• Knowledge of credentialing systems and procedures, including MITS, PNM, and more.
• Knowledge of medical billing and coding (CPT, ICD-10, HCPCS) and HIPAA regulations.

Responsibilities

• Obtain prior authorizations from insurance companies for behavioral health and addiction recovery services and medications.
• Review client medical records and treatment plans to determine medical necessity.
• Submit prior authorization requests and follow up on status.
• Communicate with providers, insurers, and clients to gather information.
• Ensure compliance with insurance requirements and guidelines.
• Maintain accurate records of prior authorization requests and approvals.
• Collaborate with billing and clinical teams to facilitate the process.
• Process and submit insurance claims and verify coverage.
• Review client accounts for billing and coding accuracy.
• Follow up on unpaid claims and denials and resubmit as needed.
• Maintain HIPAA compliance and client confidentiality.

Skills

Microsoft Office

Google Workspace

Billing software

EMR systems

Credentialing processes

Prior-Authorization

HIPAA

Communication skills

Problem-solving

Multitasking

Education

High School Diploma

Associates/Bachelor's in healthcare administration

Tools

Medicaid billing software

Microsoft Excel

Billing software

Electronic Medical Records (EMR)

Job description

Team Recovery is seeking a Prior Authorization Specialist to manage pre-authorization processes for behavioral health and addiction recovery services. You will work with providers, insurers, and clients to ensure timely submissions and regulatory compliance.

The role requires 3+ years in credentialing, prior-authorization, and insurance reimbursement, with preference for behavioral health experience. Strong communication, multitasking, and EMR proficiency are essential for success.