PRP/BHH Prior Authorization Specialist

The PRP/BHH 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.

Requirements

• Collect and verify intake documentation for new clients referred to PRP and BHH 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