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

• Employee Type Full Time- Exempt
• Required Degree High school

Contact information

• Name HR

About Team Recovery:Team Recovery is an addiction treatment center dedicated to supporting individuals affected by substance use and mental health disorders. We offer a full continuum of care, including inpatient detox, residential treatment, outpatient services, and recovery housing, designed to meet people where they are in their recovery journey. Our team is made up of professionals, many with lived experience, who understand the challenges of addiction and the power of connection. With a mission to improve lives and a vision to redefine treatment, we're committed to creating lasting change in the communities we serve. Team Recovery is more than a treatment center. We're a new approach to an old problem.

Job Summary: The Prior Authorization Specialist is responsible for managing the pre-authorization processes to ensure the timely submission of requests to insurance companies for healthcare services provided. They will work closely with healthcare providers, insurance companies, and other stakeholders to ensure compliance with regulatory standards and maximize revenue collection in a timely and efficient manner.

Core 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 the medical necessity of requested services.
• Submit prior authorization requests to insurance companies and follow up on the status of pending requests.
• Communicate with healthcare providers, insurance companies, and clients to gather necessary information for prior authorizations.
• Ensure compliance with insurance requirements and guidelines for prior authorizations.
• Maintain accurate records of prior authorization requests and approvals.
• Stay up to date on insurance policies and guidelines related to addiction recovery services.
• Collaborate with the clinical team and billing department to facilitate the prior authorization process.
• Process and submit insurance claims.
• Verify insurance coverage and benefits for clients seeking behavioral health and addiction recovery treatment.
• Review client accounts and ensure accurate billing and coding of services provided.
• Follow up on unpaid claims and denials, and resubmit claims as necessary.
• Communicate with insurance companies, clients, and healthcare providers to resolve billing issues.
• Stay up-to-date on insurance regulations and billing guidelines related to behavioral health and addiction recovery services.
• Maintain client confidentiality, adhere to 42 CFR, and HIPAA regulations.
• Collaborate with revenue cycle management, finance, and clinical staff to ensure accurate and timely billing practices.
• Provide excellent customer service to clients regarding billing inquiries and concerns.
• Attend required staff training and development meetings.
• Flexibility to adapt to schedule changes and assumption of responsibilities not delineated in the job description which are related to work as a member of an addiction treatment team.

Education Requirements:

• High School Diploma or GED required.
• Associates or bachelor's degree in healthcare administration from an accredited college or university preferred.

License Requirements: None.

Experience Requirements:

• 3 or more years of experience and a strong understanding of the credentialing, prior-authorization, and insurance reimbursement processes preferred.
• Experience in the Behavioral Health and SUD treatment field preferred.
• Ability to read and interpret written information; write clearly and informatively; edits work for spelling and grammar.
• Ability to speak clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills; and participates in meetings.
• Must have excellent problem-solving and decision-making skills with the ability to work under pressure, manage conflict, and appropriately prioritize responsibilities.
• Working knowledge of Microsoft Office Suite (Word, Excel, Powerpoint, OneNote, Calendar, Outlook, and Teams).
• Working knowledge of Google Workplace (Docs, Sheets, Slides, Forms, Gmail, Chat, Spaces, Keep, Tasks, Calendar, and Meet).
• Ability to manage multiple tasks/projects, and deadlines simultaneously and to identify and resolve exceptions and to interpret data.
• Proficiency in using billing software and Electronic Medical Records (EMR) systems.
• In-depth knowledge of Credentialing systems and procedures, including MITS, PNM, and more.
• In-depth knowledge of Medical Billing and Coding systems and procedures, including CPT, ICD-10, HCPCS coding, and more.
• Knowledge of submitting and following up on Prior-Authorizations.
• Proficiency with insurance guidelines, including Medicaid and private insurance carriers.
• Understanding of HIPAA regulations and ability to maintain confidentiality of patient information.
• Knowledge of Federal, State and Municipal laws and/or regulations that regulate the treatment of alcoholism and drug addiction, including:
  • Confidentiality
  • Patient Rights
  • Professional Code of Ethics
  • Discrimination

Why You'll Love Working with Us: We believe in taking care of our team, both in and out of the workplace. Full-time employees (30+ hours/week) enjoy a comprehensive benefits offering, including:

• Competitive Pay + 401(k) with Employer Match– Plan for your future with confidence.
• Generous Paid Time Off– We value work-life balance and encourage time to recharge.
• Tuition Reimbursement– Invest in your growth with support for ongoing education.
• Comprehensive Medical, Dental & Vision Insurance– Your health and well-being matter.
• Employee Assistance Program – Get confidential support when you need it most.