Remote Authorization Specialist - Behavioral Health (PHP/IOP)

Triwill Group; United States; Remote; USD 68,770,000 - 74,501,000; Full time

Job summary

Santa Barbara Cottage Hospital is seeking a Remote Authorization Specialist to manage insurance authorizations for PHP and IOP programs, ensuring uninterrupted client access by handling pre-certifications, concurrent reviews, and appeals across payer plans.

In this remote role you will verify benefits, obtain Single Case Agreements, build medical necessity cases using ASAM LOCUS CALOCUS criteria, and maintain audit-ready records while advocating with payers.

Qualifications

• 2+ years of UR/authorization experience at PHP/IOP for mental health or SUD facilities.
• Knowledge of ASAM, LOCUS and CALOCUS criteria and medical necessity standards.
• Strong organizational skills to manage multiple authorizations and deadlines.
• Familiarity with EMR platforms and authorization software.
• Excellent written and verbal communication; ability to advocate with payers.
• Eligible for DCF and AHCA Level 2 Background Check.

Responsibilities

• Verify benefits and eligibility prior to admission and throughout treatment.
• Complete pre-certifications, concurrent reviews, and re-certifications for PHP/IOP levels of care.
• Obtain Single Case Agreements with out-of-network payers.
• Build the medical necessity case using ASAM, LOCUS, and CALOCUS criteria.
• Prepare and submit appeals on denied authorizations.
• Maintain accurate, audit-ready authorization, denial, and SCA records.

Skills

UR/Authorization experience

ASAM LOCUS CALOCUS familiarity

EMR platforms experience

Payer advocacy

Tools

Kipu EMR

Authorization software

Job description

Santa Barbara Cottage Hospital is seeking a Remote Authorization Specialist to manage insurance authorizations for PHP and IOP programs, ensuring uninterrupted client access by handling pre-certifications, concurrent reviews, and appeals across payer plans.

In this remote role you will verify benefits, obtain Single Case Agreements, build medical necessity cases using ASAM LOCUS CALOCUS criteria, and maintain audit-ready records while advocating with payers.