Authorization & Referral Specialist

Who is Comprehensive Healthcare?Comprehensive Healthcare provides innovative behavioral health and integrated healthcare services to clients of all ages. We take pride in our creative and collaborative work environment and in delivering clinically excellent, trauma-informed, recovery-oriented services.What are we looking for in an Authorization & Referral Specialist?This role supports authorization processes across multiple programs and service lines within the organization. The Authorization Specialist is responsible for coordinating and managing prior authorizations and referrals across the organization, including interpretation of payer requirements, verification of coverage, and ensuring compliance with authorization guidelines prior to service delivery.Authorization Specialist duties may include:Coordinates and manages prior authorizations across multiple programs within the organization.Participates in process improvement efforts related to authorization workflows and payer compliance.Reviews and interprets payer requirements to determine authorization necessity and coverage limitations prior to service delivery.Submits authorization requests with appropriate clinical documentation and ensures compliance with payer guidelines.Understands funding source requirements (i.e., Medicare, Medicaid, and private insurance).Performs detailed verification of insurance benefits and eligibility to support accurate authorization submission.Identifies and resolves discrepancies related to payer requirements, coverage, and authorization status.Monitors authorization timelines and proactively follows up to prevent delays or denials.Communicates payer requirements, authorization status, and coverage limitations to internal teams.Collaborates with clinical and administrative staff to ensure appropriate documentation supports medical necessity.Maintains current knowledge of Medicare, Medicaid, and commercial payer policies.Identifies potential financial liability scenarios and escalates as appropriate.Qualifications:High school diploma or equivalent is required.Minimum one (1) year of experience in a healthcare setting requiredMinimum one (1) year of experience in insurance verification, prior authorizations, or healthcare revenue cycle functions required.Preferred qualifications:Two (2) to three (3) years of experience in healthcare, authorizations, or utilization management strongly preferred. Knowledge of Medicare, Medicaid, and commercial insurance payer requirements.Experience working with prior authorizations across multiple service lines or programs.Ability to interpret insurance benefits, coverage limitations, and authorization requirements.Experience with electronic health records (EHR) and payer portals.Understanding of coordination of benefits and payer hierarchyStrong attention to detail and ability to analyze and resolve payer-related issues.What Comprehensive Healthcare Can Offer YouTraining and DevelopmentInnovative Program & ServicesExcellent BenefitsA variety of career opportunities in a wide range of settings with room for mobility and promotionRegular training opportunities including support, supervision, and consultation in implementing evidence-based services and programsA strong reputation for providing quality, evidence-based services within a collaborative multi-disciplinary team environmentInnovative, forward-looking leadership that seeks to thrive in an ever-changing healthcare environmentJoint Commission-accredited organization committed to continuous quality improvementEstablished partnerships with major research universities and other community and healthcare providers to implement cutting-edge treatment programs and servicesCompetitive salaries within our communities and industryHealthcare coverage for employee and qualified family membersGenerous vacation, paid holiday and sick leave policiesAccess to Employee Assistance Program servicesAgency-funded retirement plan with contributions equal to 5% of compensationAdditional retirement investment opportunities with a 50% investment match of up to 4% of compensationAgency-funded life and disability insurance programFinancial incentives to further employee educationComprehensive Healthcare is proud to be an equal opportunity employer. We do not discriminate based on race, sex, age, color, religion, national origin, sexual orientation, gender identity or expression, marital status, veteran status, disability status, or any other basis prohibited by federal, state, or local law. We value the diverse perspectives and strengths that our employees bring to the workplace and we encourage individuals from underrepresented groups to apply for our positions. #J-18808-Ljbffr