Payer Authorization Specialist

   Investigate and resolve payer and agency denials.

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Review denial reasons and coordinate corrective actions with clinical and billing staff.

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Submit initial, concurrent, and retrospective authorization requests as required.

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Monitor authorization expirations and obtain extensions before services lapse.

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Track denied claims and authorizations through resolution.

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Communicate authorization requirements and deficiencies to clinical staff.

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Work directly with Medicaid managed care organizations and commercial insurance plans regarding authorization issues.

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Prepare and submit reconsiderations and appeals when appropriate.

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Maintain accurate documentation of all payer communications and authorization activity.

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Identify denial trends and recommend process improvements to reduce future denials.

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Assist with audits related to authorizations and payer compliance.

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Maintain knowledge of payer guidelines, Ohio Medicaid requirements, and agency regulations.

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Collaborate with the billing department to ensure timely claim submission and reimbursement.

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Perform other related duties as assigned.

Qualifications/ Education/Experience Requirements:

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High school diploma or GED required; associate degree preferred.

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One to three years of experience in medical billing, prior authorizations, insurance verification, or behavioral health preferred.

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Experience with Medicaid managed care organizations and behavioral health billing is strongly preferred.

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Knowledge of medical terminology, payer authorization processes, and insurance denials.

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Strong organizational and problem-solving skills.

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Excellent written and verbal communication skills.

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Ability to manage multiple priorities while meeting deadlines.

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Proficiency with electronic health records and Microsoft Office applications.

Performance Expectations

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Maintain timely submission and follow-up of all authorization requests.

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Minimize preventable authorization-related denials.

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Meet departmental productivity and accuracy standards.

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Maintain complete and accurate documentation.

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Demonstrate professionalism, accountability, and effective communication.

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Support continuous improvement initiatives that reduce denials and improve reimbursement