Authorization Specialist

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Job Description

Role: Authorization Specialist

Contract: Part-time Remote Contractor (80 hours monthly)

Business Hours: Monday through Friday, Flexible within 8 AM - 4 PM EST

Rate: $12.50 - $15 USD hourly / $1,000 - $1,200 monthly (Salary is negotiable depending on experience and location)

Availability to Start: Immediately

Company Profile

This established Maryland-based mental health and rehabilitation center specializes in delivering compassionate, patient-centered care for individuals seeking support with psychiatric conditions, substance abuse recovery, and physical rehabilitation. With a strong focus on personalized treatment, the center provides services in psychiatric rehabilitation, substance abuse programs, sports therapy, and medication-assisted treatment.

What You'll Do

As an Authorization Specialist, you will be the critical link between clinical care and financial sustainability in a behavioral health and substance use disorder (SUD) setting, ensuring patients receive timely authorization approvals for essential treatments such as MAT (Medication-Assisted Treatment) and intensive outpatient care. Responsibilities include, but are not limited to:

Core Responsibilities:
- Authorization Management & Payer Communication
  - Verify insurance eligibility and benefits for incoming patients (Medicaid, Medicare, and commercial payers) prior to intake.
  - Review clinical documentation to ensure it supports medical necessity and submit authorization requests via payer portals or fax.
  - Track and manage authorization status, including timely follow-ups on pending requests.
  - Monitor expiring authorizations and coordinate renewals to prevent gaps in patient care (e.g., IOP or MAT services).
  - Act as a point of contact for payer representatives to check status, clarify requirements, and resolve routine issues.
  - Coordinate with clinicians to obtain required documentation or additional information for submissions and resubmissions.
  - Collaborate with clinical, billing, and operations teams to ensure alignment across patient care and revenue cycle processes.
  - Provide updates on authorization status to internal stakeholders as needed.
  - Communicate with patients or families regarding insurance coverage, authorization status, and next steps in a clear, professional, and empathetic manner.
  - Escalate authorization or coverage issues that may impact patient care.
  - Coordinate with the billing team on cases that may require self-pay or alternative payment arrangements.
  - Update the Electronic Health Records (EHR) to ensure accuracy across all patient authorizations and notes.
- Denials, Documentation & Data Accuracy
  - Assist in reviewing and addressing authorization-related denials, including supporting resubmissions when applicable.
  - Identify documentation gaps and communicate feedback to clinicians to improve approval rates.
  - Maintain accurate and up-to-date authorization records in the EHR, including authorization numbers, date ranges, and approved units.
  - Track and document authorization outcomes (approved, denied, pending) to support visibility and reporting.
Extended Scope (Nice-to-Have):
- Payer Contracting & Rate Negotiation
  - Support payer contracting activities, including participating in reimbursement rate discussions and gathering required data for negotiations.
  - Assist in coordinating communications with insurance carriers related to contract updates or reimbursement terms.
  - Support credentialing processes by preparing and organizing required documentation and tracking application status.

What You Should Have

Must-haves:

At least 2 years of experience in prior Insurance Authorizations within Behavioral Health, General Healthcare or SUD treatment.
At least 1 year of experience working in a remote, global setup with a North America-based company.
Strong experience verifying benefits, submitting authorizations, and managing follow-ups across commercial, Medicaid, and Medicare payers.
Advanced proficiency with Electronic Health Records (EHR) & CRM systems (e.g., InSync, Behave Health, or similar platform).
Proficiency with payer portals (e.g., Availity, Optum, Beacon/Carelon) and EHR systems.
Solid understanding of HIPAA and healthcare data privacy requirements.
Familiarity with Medicaid/MCO authorization workflows (Maryland experience preferred).
Strong attention to detail and ability to manage high-volume authorization workflows with accuracy.
Excellent communication skills, with the ability to interact professionally with payers, clinicians, and patients.
Ability to manage multiple priorities, follow up persistently, and ensure timely resolution of authorization requests.
Technology Specifications:
- Minimum 100 Mbps Internet Speed
- Windows 11 or macOS 15 Sequoia
- Minimum Intel i5 8th gen with 8GB of RAM or Apple M1 chip with 8GB of RAM
- Webcam and Headset
- Designated Office Space in your Home

Nice-to-haves:

Exposure to payer contracting, provider relations, or reimbursement discussions.
Experience supporting contract-related processes such as credentialing or Single Case Agreements (SCAs).
Basic understanding of reimbursement models (e.g., Fee-for-Service vs. Value-Based Care).
Ability to review or support analysis of insurance contracts or carve-out structures.
Active Medical Coding Certification (e.g., CPC or CCS-P).
Clinical background or healthcare-related degree (e.g., nursing, pre-med, public health) is a plus.

Who You Are

We hope you are someone who:

Persistent and solution-oriented when handling complex or delayed insurance authorizations.
Communicates sensitive coverage outcomes with empathy, professionalism, and composure.
Highly organized, resilient, and able to manage high volumes of administrative work while collaborating effectively across teams.

Job Information

Rate / Salary

$12.50 - $15 per Hour

Sector

Healthcare