Prior Authorization Specialist

CredSpun LLC; United States; Remote; USD 30,000 - 41,000; Full time

Job summary

CredSpun LLC is seeking a remote Prior Authorization Specialist to manage the end-to-end process of prior authorizations for behavioral health services. You will determine which services require authorization, submit documentation, and monitor follow-ups to ensure timely approvals.

Responsibilities include tracking authorized visits, managing expiry dates, and alerting the practice before authorizations lapse.

Qualifications

• One or more years of prior authorization or referral coordination.
• Experience with payer portals and fax-based authorization workflows.
• Basic medical terminology and comfort reading clinical notes.
• Persistence, organisation and clear communication with payers and providers.

Responsibilities

• Identify services that need prior authorization by payer and plan.
• Submit authorization requests with the clinical documentation the payer asks for.
• Follow up until each request is approved, pended or denied, and record the outcome.
• Track authorized units, visits used and expiry dates, and request extensions in time.
• Alert the practice before a patient runs out of authorized visits.
• Coordinate peer-to-peer reviews and retro-authorization requests when allowed.
• Attach authorization numbers to claims so they are not denied for missing auth.

Skills

Prior authorization experience

Payer portals

Reading clinical notes

Persistence and organization

Clear communication with payers and a/

Tools

Fax-based authorization workflows

Job description

Prior Authorization Specialist — Remote Medical Office

File prior authorizations, chase each one to a decision, and track visit counts and expiry dates so care isn't delivered without approval.

An authorization that was never filed, or lapsed partway through a course of treatment, turns into a denial that is hard to overturn. In behavioral health especially, authorizations cover a set number of sessions for a set period, and someone has to watch both. As a prior authorization specialist you are that someone.

What you will do

• Identify services that need prior authorization by payer and plan
• Submit authorization requests with the clinical documentation the payer asks for
• Follow up until each request is approved, pended or denied, and record the outcome
• Track authorized units, visits used and expiry dates, and request extensions in time
• Alert the practice before a patient runs out of authorized visits
• Coordinate peer-to-peer reviews and retro-authorization requests when allowed
• Attach authorization numbers to claims so they are not denied for missing auth

What you need

• One or more years of prior authorization or referral coordination
• Experience with payer portals and fax-based authorization workflows
• Basic medical terminology and comfort reading clinical notes
• Persistence, organisation and clear communication with payers and providers

Helpful, not required

Behavioral health, psychiatry or imaging authorization experience, and knowledge of Medicaid managed care authorization rules.

Working remotely at CredSpun

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