About the prior authorization role
An authorization that was never filed, or lapsed partway through a course of treatment, turns into a denial that is hard to overturn. In behavioral health especially, authorizations cover a set number of sessions for a set period, and someone has to watch both. As a prior authorization specialist you are that someone.
What you will do
- Identify services that need prior authorization by payer and plan
- Submit authorization requests with the clinical documentation the payer asks for
- Follow up until each request is approved, pended or denied, and record the outcome
- Track authorized units, visits used and expiry dates, and request extensions in time
- Alert the practice before a patient runs out of authorized visits
- Coordinate peer-to-peer reviews and retro-authorization requests when allowed
- Attach authorization numbers to claims so they are not denied for missing auth
What you need
- One or more years of prior authorization or referral coordination
- Experience with payer portals and fax-based authorization workflows
- Basic medical terminology and comfort reading clinical notes
- Persistence, organisation and clear communication with payers and providers
Helpful, not required
Behavioral health, psychiatry or imaging authorization experience, and knowledge of Medicaid managed care authorization rules.
Working remotely at CredSpun
This is a fully remote, work-from-home role open to applicants living in the United States. You work during U.S. business hours alongside a named account team, inside each client practice's own EHR and practice management system, with every login tied to you personally. You need a quiet, private workspace, a reliable broadband connection and a computer that can run a current browser and a second monitor. HIPAA training is part of onboarding, and you sign our confidentiality terms before you are given access to any patient data.