Billing Services Authorization (UR) Specialist

Ritten; Philadelphia (Philadelphia County); Hybrid; USD 60,000 - 90,000; Full time

Job summary

Ritten is seeking an Authorization / Utilization Review (UR) Specialist to join our Revenue Cycle Management team. This role manages prior authorizations and concurrent reviews across behavioral health levels of care and multiple states, ensuring coverage and proper documentation for clean claim submission.

You will collaborate with clinical, intake, and billing teams to prevent denials and maintain accurate authorization records, while guiding payer interactions and extensions when needed.

Qualifications

• 3+ years of utilization review or prior authorization experience in a behavioral health or mental health setting.
• Experience obtaining authorizations across multiple levels of care (IOP, PHP, Residential, Detox).
• Strong knowledge of medical necessity criteria for behavioral health, including ASAM criteria for substance use disorder.
• Experience working with commercial insurance, Medicaid, and Medicare UR departments across multiple states.
• Familiarity with concurrent review processes and managing continued stay authorizations.
• Experience managing retro-authorization requests and authorization-related denial appeals.

Responsibilities

• Obtain prior authorizations for all levels of care including IOP, PHP, Residential, and Detox.
• Submit initial authorization requests to payers with clinical documentation and medical necessity criteria.
• Conduct and manage concurrent reviews to request continued stay authorizations.
• Track authorization expiration dates and proactively request extensions before coverage lapses.
• Maintain authorization records and ensure accurate system entries for claims submission.

Skills

Utilization review

Prior authorization

Behavioral health

Payer communication

Organization

Tools

EHR software

Payer portals

Job description

Authorization (UR) Specialist

Billing Services

Full-time

Hybrid

The Authorization (UR) Specialist plays a critical role in securing and managing prior authorizations and concurrent reviews across behavioral health levels of care. This person works closely with clinical, intake, billing, and payer teams to prevent coverage gaps, reduce authorization-related denials, and support clean claim submission.

About Ritten

Ritten is building the next generation of Electronic Health Records (EHR) and practice management tools for Behavioral Health providers. We empower clinicians and admin teams with intuitive software that simplifies care delivery, improves outcomes, and supports sustainable growth. Backed by top-tier investors, we're scaling quickly and on a mission to transform behavioral health.

Role Overview

We're looking for an experienced Authorization / Utilization Review (UR) Specialist to join our Revenue Cycle Management team. This role is responsible for obtaining, managing, and maintaining prior authorizations and concurrent reviews across all levels of behavioral health care and multiple states and payers. You are the frontline defense against authorization-related denials - ensuring that every level of care a client receives is covered, documented, and approved before and during treatment. You'll work closely with clinical and intake teams upstream and the Billing Specialist downstream to make sure authorizations are in place, accurate, and properly communicated so that clean claims can be submitted without delays.

Key Responsibilities:

Prior Authorization & Concurrent Review

• Obtain prior authorizations for all levels of care including, Intensive Outpatient (IOP), Partial Hospitalization (PHP), Residential (RTC), and Detox/Withdrawal Management
• Submit initial authorization requests to payers with appropriate clinical documentation and medical necessity criteria (including ASAM criteria where applicable)
• Conduct and manage concurrent reviews to request continued stay authorizations, ensuring no gaps in coverage during a patient's episode of care
• Track authorization expiration dates and proactively request extensions before coverage lapses
• Support clinical teams with payer guidance on expected clinical assessments and documentation

AuthorizationManagement

• Maintain accurate and up-to-date authorization records including approved dates of service, authorized units, level of care, and payer reference numbers
• Ensure authorization details are entered correctly in the system and accessible to the billing team prior to claim submission
• Monitor authorization limits and alert clinical and billing teams when authorized units are nearing exhaustion
• Manage retro-authorization requests when services were rendered without prior approval, working within payer timelines and requirements

Payer Communication

• Serve as the primary point of contact with payer UR departments for authorization requests, peer-to-peer reviews, and appeals
• Facilitate peer-to-peer reviews between payer medical directors and treating clinicians when authorization is denied or reduced
• Navigate payer-specific authorization requirements across commercial insurance, Medicaid, and Medicare across multiple states
• Stay current on payer medical necessity criteria, authorization portals, and submission requirements

DenialPrevention & Appeals Support

• Identify and escallate authorization gaps, mismatches, or denials that could impact claim submission or payment
• Support the AR and denial management team with authorization-related denial appeals by providing documentation, authorization records, and payer correspondence

  Cross-FunctionalCoordination

  • Work closely with intake and admissions teams to initiate authorization requests at the time of admission and verify benefits and coverage requirements
  • Collaborate with clinical and utilization review teams to gather and submit appropriate medical necessity documentation for initial and concurrent reviews
  • Communicate authorization approvals, limitations, and denials to the Billing Specialist in a timely manner to support clean claim submission
  • Flag documentation deficiencies or clinical record gaps to the appropriate upstream team members before they impact authorization outcomes
  Qualifications

  Required

  • 3+ years of utilization review or prior authorization experience in a behavioral health or mental health setting
  • Experience obtaining authorizations across multiple levels of care (IOP, PHP, Residential, Detox)
  • Strong knowledge of medical necessity criteria for behavioral health, including ASAM criteria for substance use disorder
  • Experience working with commercial insurance, Medicaid, and Medicare UR departments across multiple states
  • Familiarity with concurrent review processes and managing continued stay authorizations
  • Experience managing retro-authorization requests and authorization-related denial appeals
  • Strong organizational skills with the ability to manage a high volume of authorizations and track deadlines across multiple clients and payers
  • Proficiency with practice management or EHR software and payer authorization portals

  Preferred

  • Experience working with clients or facilities across multiple states with varying Medicaid authorization requirements
  • Familiarity with peer-to-peer review processes and how to prepare clinicians for them
  • Knowledge of ICD-10 diagnosis codes and how they relate to level of care and medical necessity
  • Experience working in a SaaS, health tech, or billing services environment supporting multiple clients
  • Certified Behavioral Health Case Manager (CBHCM) or similar credential a plus
  What Success Looks Like
  • Authorizations are obtained prior to or at the time of admission with no coverage gaps
  • Concurrent reviews are completed on time with no lapses in authorized days
  • The billing team always has accurate, complete authorization information before submitting claims
  • Authorization-related denials are minimized, and when they occur, appeals are well-supported and timely

  Compensation

  We offer competitive compensation packages, including strong cash salaries benchmarked against top startups at our stage, along with comprehensive healthcare benefits.

  Location/Work Policy

  We're a hybrid-friendly company with an expectation of about 1-2 days per week in the office for employees located near New York City, Philadelphia, Denver, or Washington, D.C.