Job description
PRP Prior Authorization Specialist
Location: Remote (Philippines)
Company: Enterprise Management Solutions, LLC
Work Setup: Remote
Job Type: Independent Contractor (W-8BEN) – Full-Time
Shift & Schedule: Monday through Friday, 8:00 AM – 5:00 PM Eastern Time (EST)
Pay Rate: $5- $5.50 (commensurate with qualifications and experience)
Travel: None
Benefits: Not eligible (Independent Contractor position)
Job Description
The PRP Prior Authorization Specialist is responsible for coordinating the intake and prior authorization process for clients referred to the Community Wellness Psychiatric Rehabilitation Program (PRP) and Behavioral Health Home programs. This role ensures that all required clinical documentation is complete, authorization requests are submitted accurately and on time, and payer requirements are met to prevent interruptions in client services.
Working closely with clinical, scheduling, and administrative teams, the PRP Prior Authorization Specialist tracks authorization approvals, manages renewals, maintains accurate electronic records, and supports regulatory compliance with Maryland Medicaid, Managed Care Organizations (MCOs), COMAR requirements, and company policies. The position plays a critical role in ensuring clients receive timely access to behavioral health services while maximizing reimbursement opportunities.
Key Responsibilities
Collect, review, and verify intake documentation for new PRP referrals
Review payer requirements and authorization timelines for Maryland Medicaid and Managed Care Organizations (MCOs)
Prepare, submit, monitor, and track initial and continuing prior authorization requests
Monitor authorization expiration dates and proactively initiate renewal requests
Coordinate with providers and clinical staff to obtain missing documentation, signatures, or supporting clinical information
Update electronic health records (EHR) and internal tracking systems with authorization status and required follow-up
Ensure all authorization requirements are completed at least three (3) business days prior to scheduled service delivery
Notify scheduling and clinical departments regarding authorization approvals, denials, delays, or pending requests
Support intake coordination and respond to referral inquiries as assigned
Maintain organized electronic authorization records to support audits and regulatory compliance
Assist with insurance eligibility verification and benefit reviews during high-volume periods
Participate in weekly authorization meetings, cross-training, and workflow improvement initiatives
Support quality assurance activities, payer audits, compliance reviews, and performance improvement projects
Provide coverage for other authorization team members during absences or operational needs
Maintain confidentiality of client and organizational information in accordance with HIPAA and company policies
Licenses / Qualifications
High school diploma or equivalent required
Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred
Ability to successfully complete required background and reference checks
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
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, Microsoft Office, 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
What We Offer
Competitive hourly compensation
Full-time remote work opportunity
Stable long-term engagement
Ongoing training and professional development
Exposure to U.S. behavioral healthcare operations and payer systems
Collaborative and supportive team environment
Opportunities to develop expertise in behavioral health prior authorization and revenue cycle operations
Salary: $5- $5.50Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.