Behavioral Health UR/Authorization Specialist

Authorization Specialist

On-Site | Full-Time | 9a-5p Monday-Friday | $25-$30/hour

This role manages insurance authorization for clients across our PHP and IOP programs completing pre-certifications, concurrent reviews, verifying benefits, obtaining Single Case Agreements, and managing appeals so that client access to treatment is never disrupted by a payer issue.

Utilization Review Insurance Authorization/Precertification

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

Required

4+ years of experience as a UR/authorization specialist at the PHP and IOP levels of care for a mental health or substance use facility

Working knowledge of ASAM, LOCUS, and CALOCUS criteria and medical necessity standards

Strong organizational skills with the ability to manage multiple authorizations and deadlines concurrently

Strong familiarity with EMR platforms and authorization software

Strong written and verbal communication skills, with the ability to advocate effectively with payers

Eligible for DCF and AHCA Level 2 Background Check

Preferred

CPT/ICD-10 and DSM-5 familiarity

Multi-payer SCA experience

Bilingual (English/Spanish)

Kipu or similar EMR experience

AWA and PRC are dual behavioral health organizations operating PHP and IOP programs across South Florida. We exist to serve clients and families at their most critical moments and this role sits at the front door of that mission.