Prior Authorization Specialist

Prior Authorization Specialist

At The Remedy, the Prior Authorization Specialist plays an integral role in the patient intake and revenue cycle process. This role will focus on the coordination and management of medication and treatment prior authorizations for a mental health organization, ensuring accuracy, timely submission, and alignment with payer guidelines to support uninterrupted patient care.

This role leverages expertise in insurance verification and authorization processes to confirm benefits and eligibility, collect necessary documentation, and submit prior authorization requests to support timely and accurate reimbursement. This is an onsite position based in Vadnais Heights, MN.

Duties/Responsibilities

• Educates patients prior to appointments on their benefits, including differences between medical and behavioral health coverage, to support informed treatment decisions.
• Contacts payers to verify insurance benefits and eligibility for behavioral health services via online portals, eligibility systems, or direct communication.
• Ensures all benefit information is accurately documented to reduce rework and support clean claim submission.
• Requests and collects required clinical documentation from providers to support authorization approvals.
• Prepares and submits prior authorization requests to commercial and government payers.
• Organizes patient medical records for prior authorization and appeals processes as needed.
• Tracks and monitors the status of prior authorization requests and appeals, documenting updates in PM/EMR systems.
• Posts payer authorization decisions in a timely and accurate manner prior to services to ensure financial clearance, enhance patient experience, and support timely reimbursement.
• Identifies and reports payer trends or patterns impacting authorizations.
• Communicates proactively with patients to provide updates and address questions throughout the authorization process.
• Performs other duties as assigned.
• Serve as a liaison between providers, patients, and internal departments, facilitating clear communication to support accurate workflows and positive patient outcomes.

Required Skills/Abilities

• Excellent verbal and written communication skills.
• Strong interpersonal, negotiation, and conflict resolution skills.
• Exceptional organizational skills with strong attention to detail.
• Strong analytical and problem-solving abilities.
• Ability to prioritize tasks effectively.
• Demonstrated integrity, professionalism, and ability to maintain confidentiality.
• Proficiency in Microsoft Office Suite and healthcare systems (PM/EMR preferred).

Education and Experience

• High school diploma or equivalent required; Associate's or Bachelor's degree in healthcare administration or related field preferred.
• 13 years of experience in prior authorization, insurance verification, or revenue cycle operations required.
• Experience working with behavioral health services strongly preferred.
• Familiarity with commercial and government payers (e.g., Medicare, Medicaid) required.
• Experience using PM/EMR systems and payer portals (e.g., Availity or similar) preferred

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.

The Remedy Mental Health offers a comprehensive benefits package and provides eligible employees with an opportunity to enroll in various benefit programs, subject to applicable waiting periods. This includes the following:

• Paid Time Off
• Holiday Pay
• Medical Insurance
• Health Savings Account
• Dental Insurance
• Vision Insurance
• 401(k) with Employer Match
• Life Insurance and AD&D
• Short-Term Disability

EEO Statement:

The Remedy Mental Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, veteran status, or any other protected status.

Disclaimer:

This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the position. Duties may change based on business needs.

Work Authorization Requirement: All candidates must be legally authorized to work in the United States. The company does not currently sponsor employment visas.