Hybrid Prior Authorization & Utilization Review Specialist

Ritten; Philadelphia (Philadelphia County); Híbrido; USD 60 000 - 90 000; Tempo integral

Resumo da oferta

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.

Qualificações

• 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.

Responsabilidades

• 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.

Conhecimentos

Utilization review

Prior authorization

Behavioral health

Payer communication

Organization

Ferramentas

EHR software

Payer portals

Descrição da oferta de emprego

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.