Prior Authorization Specialist

Job description

About the Role:
Woodhaven Residential Treatment Center is hiring a fully remote Prior Authorization Specialist to support our Utilization Management team. In this role, you'll handle prior authorization submissions, denials and appeals, and ensure accurate clinical documentation that meets insurance, billing, and compliance standards.
This is an ideal role for someone experienced in healthcare authorizations or administrative support with strong attention to detail, communication skills, and a solid understanding of insurance processes.

Key Responsibilities:
Submit, track, and manage prior authorization requests in MCO portals and EHR systems
Perform daily audits to ensure medical necessity and documentation accuracy
Review and file denials and appeals in collaboration with clinical teams
Maintain detailed records for internal and external audits
Communicate with insurance providers, billing, and clinical staff
Support Utilization Management leadership with data tracking and reporting

What We're Looking For
High school diploma or GED required / CDCA or Licensed Counselor preferred
MUST live in OHIO
Experience in prior authorization, billing, or medical records preferred
Strong computer skills: EHR systems, Microsoft Word & Excel
Must have a quiet, professional home office setup and reliable internet
CPR certification required before start date (company-sponsored)

What We Offer
Fully remote work (Monday-Friday, 8-hour flexible shifts)
Competitive hourly pay ($20-$25 based on experience)
Paid Time Off (PTO)
401(k) with company match
Medical, Dental, Vision, Life Insurance, STD/LTD
Supportive, mission-driven team environment

How to Apply
Submit your resume and email View email address on click.appcast.io
Call View phone number on click.appcast.io or text the HR Director directly at View phone number on click.appcast.io if you don't hear back within 48 hours.

Equal Opportunity Statement
Woodhaven is proud to be an Equal Opportunity Employer. We welcome and celebrate diversity and are committed to creating an inclusive environment for all employees.