Role: Authorization Specialist
Contract: Part-time Remote Contractor (80 hours monthly)
Business Hours: Monday through Friday, Flexible within 8 AM - 4 PM EST
Rate: $12.50 - $15 USD hourly / $1,000 - $1,200 monthly
(Salary is negotiable depending on experience and location)
Availability to Start: Immediately
What You'll Do
As an Authorization Specialist, you will be the critical link between clinical care and financial sustainability in a behavioral health and substance use disorder (SUD) setting, ensuring patients receive timely authorization approvals for essential treatments such as MAT (Medication-Assisted Treatment) and intensive outpatient care. Responsibilities include, but are not limited to:
Core Responsibilities:
- Authorization Management & Payer Communication
- Verify insurance eligibility and benefits for incoming patients (Medicaid, Medicare, and commercial payers) prior to intake.
- Review clinical documentation to ensure it supports medical necessity and submit authorization requests via payer portals or fax.
- Track and manage authorization status, including timely follow-ups on pending requests.
- Monitor expiring authorizations and coordinate renewals to prevent gaps in patient care (e.g., IOP or MAT services).
- Act as a point of contact for payer representatives to check status, clarify requirements, and resolve routine issues.
- Coordinate with clinicians to obtain required documentation or additional information for submissions and resubmissions.
- Collaborate with clinical, billing, and operations teams to ensure alignment across patient care and revenue cycle processes.
- Provide updates on authorization status to internal stakeholders as needed.
- Communicate with patients or families regarding insurance coverage, authorization status, and next steps in a clear, professional, and empathetic manner.
- Escalate authorization or coverage issues that may impact patient care.
- Coordinate with the billing team on cases that may require self-pay or alternative payment arrangements.
- Update the Electronic Health Records (EHR) to ensure accuracy across all patient authorizations and notes.
- Denials, Documentation & Data Accuracy
- Assist in reviewing and addressing authorization-related denials, including supporting resubmissions when applicable.
- Identify documentation gaps and communicate feedback to clinicians to improve approval rates.
- Maintain accurate and up-to-date authorization records in the EHR, including authorization numbers, date ranges, and approved units.
- Track and document authorization outcomes (approved, denied, pending) to support visibility and reporting
Extended Scope (Nice-to-Have):
- Payer Contracting & Rate Negotiation
- Support payer contracting activities, including participating in reimbursement rate discussions and gathering required data for negotiations.
- Assist in coordinating communications with insurance carriers related to contract updates or reimbursement terms.
- Support credentialing processes by preparing and organizing required documentation and tracking application status.
What You Should Have
Must-haves:
- At least 2 years of experience in prior Insurance Authorizations within Behavioral Health, General Healthcare or SUD treatment.
- At least 1 year of experience working in a remote, global setup with a North America-based company.
- Strong experience verifying benefits, submitting authorizations, and managing follow-ups across commercial, Medicaid, and Medicare payers.
- Advanced proficiency with Electronic Health Records (EHR) & CRM systems (e.g., InSync, Behave Health, or similar platform).
- Proficiency with payer portals (e.g., Availity, Optum, Beacon/Carelon) and EHR systems.
- Solid understanding of HIPAA and healthcare data privacy requirements.
- Familiarity with Medicaid/MCO authorization workflows (Maryland experience preferred).
- Strong attention to detail and ability to manage high-volume authorization workflows with accuracy.
- Excellent communication skills, with the ability to interact professionally with payers, clinicians, and patients.
- Ability to manage multiple priorities, follow up persistently, and ensure timely resolution of authorization requests.
Who You Are
We hope you are someone who:
- Persistent and solution-oriented when handling complex or delayed insurance authorizations.
- Communicates sensitive coverage outcomes with empathy, professionalism, and composure.
- Highly organized, resilient, and able to manage high volumes of administrative work while collaborating effectively across teams.