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
Compensation: $4.50 - $6 USD per hour
