Job description
RRP Prior Authorization Specialist
Location: Remote (Philippines)
Company: Freedom Health Systems, Inc. (Supporting affiliated customer organizations under contract)
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 RRP Prior Authorization Specialist is responsible for coordinating the prior authorization and intake process for clients entering or receiving services through the Residential Recovery Program (RRP). This position ensures all required authorizations are obtained before admission or continuation of residential treatment services, supporting timely access to care while maximizing reimbursement and maintaining compliance with payer and regulatory requirements.
Working closely with admissions, clinical, billing, and utilization management teams, the RRP Prior Authorization Specialist prepares and submits authorization requests, monitors authorization status and renewals, maintains accurate documentation, and communicates with Medicaid Managed Care Organizations (MCOs), commercial insurers, and other payers. The role is essential to minimizing treatment delays, supporting revenue cycle performance, and ensuring compliance with Maryland Medicaid, COMAR, CARF, HIPAA, and company policies.
Key Responsibilities
Collect, review, and verify intake documentation for clients referred to the Residential Recovery Program (RRP)
Review insurance eligibility, payer requirements, and authorization guidelines for each referral
Prepare, submit, and track initial and concurrent prior authorization requests for residential treatment services
Monitor authorization expiration dates and proactively submit reauthorization requests before coverage expires
Coordinate with clinical staff to obtain assessments, treatment plans, physician orders, and supporting documentation required by payers
Communicate with Medicaid Managed Care Organizations (MCOs), commercial insurance carriers, and other payers regarding authorization status
Update Electronic Health Records (EHR) and internal authorization tracking systems with accurate authorization information
Ensure authorization requests are completed within established timelines to prevent interruptions in residential services
Notify admissions, clinical, billing, and program staff regarding authorization approvals, denials, pending requests, or requests for additional information
Maintain organized electronic documentation to support regulatory compliance, payer audits, and internal quality reviews
Coordinate authorization-related requirements before client admission
Escalate urgent cases, authorization denials, or complex payer issues to appropriate clinical or supervisory staff
Assist with insurance eligibility verification and benefit reviews during periods of high referral volume
Participate in authorization meetings, cross-training, workflow improvement initiatives, and utilization management activities
Support appeals, reconsiderations, and peer-to-peer review coordination for denied authorization requests
Assist with reporting, performance metrics, and quality improvement initiatives related to authorization turnaround times and payer performance
Licenses / Qualifications
High school diploma or equivalent required
Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Health Information Management, or a related field preferred
Ability to successfully complete required background and reference checks
Experience
Minimum of 1–2 years of experience in healthcare prior authorizations, utilization management, admissions, intake coordination, or insurance verification
Experience supporting Residential Recovery Programs (RRP), Substance Use Disorder (SUD) treatment, behavioral health, or residential treatment programs strongly preferred
Working knowledge of Maryland Medicaid and Managed Care Organization (MCO) authorization requirements preferred
Experience using Electronic Health Records (EHR), payer portals, and Microsoft Office applications preferred
Competencies and Skills
Knowledge of Maryland Medicaid, Managed Care Organizations (MCOs), and behavioral health authorization processes
Understanding of Residential Recovery Programs (RRP), Substance Use Disorder (SUD), behavioral health, and residential treatment terminology
Strong knowledge of prior authorization, utilization management, and medical necessity documentation
Excellent organizational and time management skills
Strong attention to detail and ability to manage multiple concurrent authorization requests
Excellent written and verbal communication skills
Strong analytical and problem-solving abilities
Proficiency with Electronic Health Records (EHR), payer portals, Microsoft Office, and related software
Ability to work independently while collaborating effectively with multidisciplinary teams
Commitment to confidentiality, regulatory compliance, and continuous quality improvement
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 revenue cycle management
Collaborative and supportive team environment
Opportunities to develop expertise in behavioral health prior authorization, utilization management, and healthcare reimbursement systems
Salary: $5 - $5.50Originally posted on Himalayas
Who can apply
Eligible countries: Australia, Canada, Ireland, New Zealand, United Kingdom, United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC-4, UTC-3.5, UTC+0, UTC+1, UTC+8, UTC+8.75, UTC+9, UTC+9.5, UTC+10, UTC+10.5, UTC+12, UTC+12.75, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.