OMHC 先前授权 专员
OMHC Prior Authorization Specialist
OMHC 先前授权专员
地点：远程（菲律宾）
公司：Enterprise Management Solutions, LLC
工作安排：完全远程
职位类型：独立承包商（W-8BEN），全职
班次与时间表：周一至周五，东部时间（美国）上午8:00 – 下午5:00
薪资：4.50美元 - 5美元（根据经验和资质调整）
出差：无
福利：独立承包商职位；不享受员工福利
职位描述
OMHC 先前授权专员负责协调社区健康门诊心理健康中心（OMHC）和自由医疗初级护理独立综合诊所的入院、保险授权和转诊流程。该职位确保所有必要文件完整，先前授权提交准确且及时，并满足支付方的要求，以支持不间断的客户护理和及时的报销。
与临床提供者、排班、入院和收入周期团队紧密合作，OMHC 先前授权专员跟踪授权请求，管理续期，验证保险要求，并在符合医疗补助、管理护理组织（MCOs）、COMAR、CARF和组织标准的前提下维护准确的记录。
主要职责
- 收集、审核并验证新客户转介的入院文件。
- 审核保险资格、福利和支付方特定的授权要求。
- 准备、提交并跟踪初始和持续的先前授权请求。
- 监控授权状态，并主动与支付方跟进以确保及时批准。
- 在授权过期日期之前发起续期请求，以防止服务中断。
- 与提供者和临床工作人员沟通，获取缺失的文件、签名或临床信息。
- 在电子健康记录（EHR）、支付方门户和内部跟踪系统中更新授权状态。
- 尽可能在计划服务前三（3）个工作日完成所有授权要求。
- 通知临床、排班和行政团队授权批准、拒绝或延迟情况。
- 根据需要协助入院协调和转介管理。
- 维护有条理的电子记录，以支持审计准备和监管合规。
- 在高流量期间协助保险验证和福利确认。
- 参与质量改进
查看英文原文
OMHC Prior Authorization Specialist
Location: Remote (Philippines)
Company: Enterprise Management Solutions, LLC
Work Setup: Fully Remote
Job Type: Independent Contractor (W-8BEN), Full-Time
Shift & Schedule: Monday through Friday, 8:00 AM – 5:00 PM Eastern Time (U.S.)
Pay Rate: $4.50 - $5 (commensurate with experience and credentials)
Travel: None
Benefits: Independent contractor position; not eligible for employee benefits
Job Description
The OMHC Prior Authorization Specialist is responsible for coordinating the intake, insurance authorization, and referral processes for Community Wellness Outpatient Mental Health Center (OMHC) and Freedom Healthcare Primary Care Freestanding General Clinic. This role ensures that all required documentation is complete, prior authorizations are submitted accurately and on time, and payer requirements are met to support uninterrupted client care and timely reimbursement.
Working closely with clinical providers, scheduling, intake, and revenue cycle teams, the OMHC Prior Authorization Specialist tracks authorization requests, manages renewals, verifies insurance requirements, and maintains accurate records in compliance with Medicaid, Managed Care Organizations (MCOs), COMAR, CARF, and organizational standards.
Key Responsibilities
- Collect, review, and verify intake documentation for new client referrals.
- Review insurance eligibility, benefits, and payer-specific authorization requirements.
- Prepare, submit, and track initial and continuing prior authorization requests.
- Monitor authorization status and proactively follow up with payers to ensure timely approvals.
- Initiate renewal requests before authorization expiration dates to prevent service interruptions.
- Communicate with providers and clinical staff to obtain missing documentation, signatures, or clinical information.
- Update electronic health records (EHRs), payer portals, and internal tracking systems with authorization status.
- Ensure all authorization requirements are completed at least three (3) business days prior to scheduled services whenever possible.
- Notify clinical, scheduling, and administrative teams of authorization approvals, denials, or delays.
- Assist with intake coordination and referral management as needed.
- Maintain organized electronic records to support audit readiness and regulatory compliance.
- Assist with insurance verification and benefit confirmation during periods of high volume.
- Participate in quality improvement initiatives to improve authorization turnaround times and documentation accuracy.
- Support compliance reporting, payer audits, and other departmental projects as assigned.
- Perform other duties as assigned.
Licenses / Qualifications
- High school diploma or equivalent required.
- Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.
- Ability to successfully complete required background and reference checks.
Experience
- Minimum of one (1) to two (2) years of experience in healthcare administration, medical prior authorizations, insurance verification, or patient intake coordination.
- Experience with outpatient mental health (OMHC), behavioral health, psychiatric rehabilitation (PRP), or primary care authorizations preferred.
- Experience working with Maryland Medicaid, Managed Care Organizations (MCOs), or commercial insurance authorization processes preferred.
- Experience using electronic health record (EHR) systems and payer portals is highly desirable.
Competencies and Skills
- Knowledge of prior authorization and insurance verification processes.
- Familiarity with Maryland Medicaid and Managed Care Organization (MCO) authorization requirements.
- Understanding of outpatient behavioral health and medical terminology.
- Strong attention to detail and organizational skills.
- Excellent time management and ability to manage multiple authorization requests simultaneously.
- Strong written and verbal communication skills.
- Ability to prioritize tasks and meet strict deadlines.
- Proficiency with electronic health records, payer portals, Microsoft Office, and Google Workspace.
- Strong problem-solving and follow-up skills.
- Ability to work independently in a fast-paced remote environment.
- High level of professionalism, confidentiality, and integrity.
What We Offer
Independent contractors enjoy:
- Fully remote work environment
- Stable full-time schedule aligned with U.S. business hours
- Opportunity to support leading behavioral health and primary care organizations
- Collaborative and supportive remote team environment
- Ongoing cross-training and professional development opportunities
- Exposure to U.S. healthcare operations, revenue cycle management, and payer authorization processes
- Opportunities to contribute to quality improvement and operational excellence
Originally posted on Himalayas