Remote RRP Prior Authorization Specialist

Enterprise Mangement Solutions Inc; Baltimore (MD); Hybrid; USD 5,500 - 8,300; Full time

Job summary

Enterprise Management Solutions, LLC is seeking an RRP Prior Authorization Specialist for our Baltimore, MD area with remote work options. You will manage prior authorizations for Residential Recovery Program clients, coordinating with clinical staff and payers to maintain timely admissions and continuous services.

The role requires familiarity with Medicaid, MCOs, and utilization management, plus strong documentation and communication skills.

Qualifications

• High school diploma or equivalent required.
• Associate or Bachelor's in Healthcare Administration preferred.
• Experience with Maryland Medicaid and MCOs is preferred.

Responsibilities

• Collect and verify intake documentation for new RRP clients.
• Review insurance eligibility and authorization guidelines for referrals.
• Submit and track initial and concurrent prior authorization requests.
• Monitor expiration dates and submit reauthorizations before coverage lapses.
• Coordinate with clinical staff to obtain assessments and orders.
• Notify payers and update EHR with current authorization info.
• Ensure requests are completed within established timelines.

Skills

Maryland Medicaid

MCO knowledge

Behavioral health

Prior authorization

EHR proficiency

Communication skills

Education

High school diploma or equivalent

Healthcare Administration degree preferred

Tools

EHR systems

Payer portals

Microsoft Office

Job description

Enterprise Management Solutions, LLC is seeking an RRP Prior Authorization Specialist for our Baltimore, MD area with remote work options. You will manage prior authorizations for Residential Recovery Program clients, coordinating with clinical staff and payers to maintain timely admissions and continuous services.

The role requires familiarity with Medicaid, MCOs, and utilization management, plus strong documentation and communication skills.