The OMHC/FGC Prior Authorization Specialist is responsible for coordinating the intake and authorization process for clients referred to Community Wellness Outpatient Mental Health Center and Freedom Healthcare Primary Care Freestanding General Clinic. This includes ensuring all medical necessity documentation is complete, submitting timely prior authorizations, tracking approvals, and maintaining records in compliance with payer requirements.
Requirements
- Collect and verify intake documentation for new clients referred to OMHC and FGC 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
- 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
