Behavioral Health Prior Authorization Specialist

Socket.dev; Cincinnati (OH); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Comprehensive benefits

Tuition reimbursement

Job summary

TriHealth is seeking a Prior Authorization and Medical Records Specialist for outpatient behavioral health. This role coordinates insurance authorizations, reviews documentation, submits requests, tracks approvals, and manages denials and appeals to ensure timely patient access to services.

The position emphasizes accuracy, compliance, and collaboration with care teams within TriHealth Physician Practices. The role supports care delivery across PHP, IOP, neuropsychology, and medication

Qualifications

• Graduate of an approved healthcare program; clinical experience preferred.
• Equivalent experience accepted in lieu of degree.
• Must be certified or registered medical assistant and CPR.
• Knowledge of EMR, practice management software and medical coding/billing encouraged.

Responsibilities

• Demonstrates proficiency in the rooming process for adult/pediatric primary care, including clinical procedures and documentation.
• Maintains knowledge of population health and participates in closing care gaps.
• Identifies barriers to care and communicates with providers regarding patient wellness and chronic diseases.
• Collaborates with wrap-around services to support patients and provides education on wellness and disease management.
• Supports process improvements and adheres to clinical goals and patient satisfaction metrics.

Skills

Certified Medical Assistant

EMR knowledge

Front office tasks

Decision making

Practice management software

Medical coding/billing knowledge

Education

CPR certification

Healthcare program credential

Job description

TriHealth is seeking a Prior Authorization and Medical Records Specialist for outpatient behavioral health. This role coordinates insurance authorizations, reviews documentation, submits requests, tracks approvals, and manages denials and appeals to ensure timely patient access to services.

The position emphasizes accuracy, compliance, and collaboration with care teams within TriHealth Physician Practices. The role supports care delivery across PHP, IOP, neuropsychology, and medication