PRP Prior Authorization Specialist

PRP Prior Authorization Specialist

Baltimore, MD - Remote

DISCLOSURES

The specific statements shown in each section of this job description are not intended to be all-inclusive. They represent typical elements and criteria necessary to perform the job successfully. Job responsibilities may be modified or expanded over time, and the company will inform the contractor of any such changes.

ABOUT THE COMPANY

Enterprise Management Solutions, LLC (EMS) is a full-spectrum consulting and management firm specializing in back-office operations, financial infrastructure, and executive oversight for health and human services organizations. We provide strategic support to affiliated companies through contractual partnerships, optimizing operations and maintaining compliance across multiple industries including behavioral health, primary care, real estate, supportive housing, and food service.

Our goal is to relieve mission-driven companies of administrative burden by overseeing financial and operational systems that allow leadership teams to focus on quality care and innovation.

COMPANY WEBSITE: https://enterprisemanagement.org/

COMPANY PHONE NUMBER : (667) 309-5345

HR DEPARTMENT PHONE NUMBER : (667) 400-6206 EXT 10

HR DEPARTMENT EMAIL ADDRESS : [email protected]

POSITION TITLE : PRP Prior Authorization Specialist

ALTERNATE TITLE(S ): PA Coordinator, Authorization & Intake Coordinator

COMPANY : Enterprise Management Solutions, LLC

DIVISION : Accounting & Finance

DEPARTMENT : Accounts Receivables

UNIT : Prior Authorization

ACCOUNTABLE TO : Prior Authorization Unit Supervisor (Accounts Receivables Department Manager in the absence of the Prior Authorization Unit Supervisor)

ACCOUNTABLE FOR : Timely and accurate submission of authorization requests and intake coordination for PRP clients

CLASSIFICATION : Exempt – Independent Contractor (Non-U.S., W-8BEN)

WORK SCHEDULE : This schedule reflects 8 hours per day, totaling 40 hours per week, Monday through Friday, 8:00 AM–5:00 PM. Scheduling needs may vary based on business demands, and adjustments may be required as reasonably assigned.

COMPENSATION RANGE : $4.50 - $6 USD per hour

ANTICIPATED TRAVEL : N/A

SUMMARY OF POSITION RESPONSIBILITIES

The PRP (Psychiatric Rehabilitation Program) Prior Authorization Specialist is responsible for coordinating the intake and authorization process for clients referred to Community Wellness Outpatient Psychiatric Rehabilitation Program and the Behavioral Health Home. This includes ensuring all medical necessity documentation is complete, submitting timely prior authorizations, tracking approvals, and maintaining records in compliance with payer requirements.

This role ensures that all clients are fully authorized for services at least three (3) business days prior to their scheduled start date, minimizing service disruptions and maximizing reimbursement potential.

SCHEDULED DUTIES AND RESPONSIBILITIES

Collect and verify intake documentation for new clients referred to PRP programs

Review insurance requirements and authorization timelines for each payer

Prepare, submit, and track initial and continuing authorizations in compliance with MCO or Medicaid requirements

Monitor authorization expiration dates and initiate renewal requests proactively

Communicate with providers and clinical staff to obtain missing information or signatures

Update EHR systems and internal trackers with status of each authorization

Ensure all intake and authorization tasks are completed within internal timelines, including 3-day minimum prior to service

Notify clinical and scheduling departments of authorization approvals or delays

Support intake calls and triage referral inquiries as needed

Maintain organized electronic records for audit readiness and compliance

UNSCHEDULED DUTIES AND RESPONSIBILITIES

Assist your supervisor with any work-related tasks as requested, taking initiative where possible

Remain informed and compliant with regulations and standards, including COMAR, CARF, and other relevant governing bodies, as well as company policies and procedures

Support the maintenance of a safe work environment by participating in drills and safety trainings as requested

Maintain confidentiality of all records, especially those relating to client treatment or financial information

Participate in external and internal audits/surveys (CARF/CSA/OHCQ) as directed by the supervisor

Contribute to quality assurance and performance improvement plans by conducting audits and activities that ensure regulatory compliance

Assist with insurance verifications and benefit checks during high volume periods

Participate in weekly prior authorization team meetings and cross-training sessions

Cover for other team members during absences or program needs

Contribute to quality improvement initiatives related to authorization turnaround times or documentation standards

Support data collection and reporting for compliance or payer audits

PHYSICAL DEMANDS: Prolonged periods sitting at a desk and working on a computer and frequent meetings via video or phone; occasional in-person site visits

WORK CONDITIONS

Remote

Fast-paced, deadline-driven environment with collaborative teams

COMPETENCIES AND SKILLS

Knowledge of Maryland Medicaid and Managed Care Organization (MCO) authorization processes

Understanding of Psychiatric Rehabilitation Program (PRP) services and behavioral health terminology

Strong attention to detail and organizational skills

Excellent time management and ability to manage multiple authorization requests simultaneously

Strong written and verbal communication skills

Proficiency using Electronic Health Records (EHR), payer portals, and related software

Ability to work independently while collaborating effectively with cross-functional teams

Strong problem-solving and follow-up skills

Commitment to confidentiality, accuracy, and regulatory compliance

Ability to perform effectively in a fast-paced, deadline-driven remote environment

LEVEL OF EDUCATION / TRAINING / QUALIFICATIONS

Education

High school diploma or equivalent required

Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred

Certifications

Must possess at least one recognized certification in Prior Authorization.

And/or at least one recognized certification in Medical Billing and Coding.

Experience

Minimum of 1–2 years of experience in healthcare administration, prior authorization, medical intake, or insurance verification

Experience supporting behavioral health, Psychiatric Rehabilitation Programs (PRP), or outpatient mental health services preferred

Experience working with Maryland Medicaid, Managed Care Organizations (MCOs), or behavioral health payer requirements preferred

Experience using Electronic Health Record (EHR) systems and payer portals preferred