RRP Prior Authorization Specialist
RRP Prior Authorization Specialist
Location: Remote (Philippines)
Company: Freedom Health Systems, Inc. (Supporting affiliated customer organizations under contract)
Work Setup: Remote
Job Type: Independent Contractor (W-8BEN) – Full-Time
Shift & Schedule: Monday through Friday, 8:00 AM – 5:00 PM Eastern Time (EST)
Pay Rate: $5 - $5.50 (commensurate with qualifications and experience)
Travel: None
Benefits: Not eligible (Independent Contractor position)
Job Description
The RRP Prior Authorization Specialist is responsible for coordinating the prior authorization and intake process for clients entering or receiving services through the Residential Recovery Program (RRP). This position ensures all required authorizations are obtained before admission or continuation of residential treatment services, supporting timely access to care while maximizing reimbursement and maintaining compliance with payer and regulatory requirements.
Working closely with admissions, clinical, billing, and utilization management teams, the RRP Prior Authorization Specialist prepares and submits authorization requests, monitors authorization status and renewals, maintains accurate documentation, and communicates with Medicaid Managed Care Organizations (MCOs), commercial insurers, and other payers. The role is essential to minimizing treatment delays, supporting revenue cycle performance, and ensuring compliance with Maryland Medicaid, COMAR, CARF, HIPAA, and company policies.
Key Responsibilities
- Collect, review, and verify intake documentation for clients referred to the Residential Recovery Program (RRP)
- Review insurance eligibility, payer requirements, and authorization guidelines for each referral
- Prepare, submit, and track initial and concurrent prior authorization requests for residential treatment services
- Monitor authorization expiration dates and proactively submit reauthorization requests before coverage expires
- Coordinate with clinical staff to obtain assessments, treatment plans, physician orders, and supporting documentation required by payers
- Communicate with Medicaid Managed Care Organizations (MCOs), commercial insurance carriers, and other payers regarding authorization status
- Update Electronic Health Records (EHR) and internal authorization tracking systems with accurate authorization information
- Ensure authorization requests are completed within established timelines to prevent interruptions in residential services
- Notify admissions, clinical, billing, and program staff regarding authorization approvals, denials, pending requests, or requests for additional information
- Maintain organized electronic documentation to support regulatory compliance, payer audits, and internal quality reviews
- Coordinate authorization-related requirements before client admission
- Escalate urgent cases, authorization denials, or complex payer issues to appropriate clinical or supervisory staff
- Assist with insurance eligibility verification and benefit reviews during periods of high referral volume
- Participate in authorization meetings, cross-training, workflow improvement initiatives, and utilization management activities
- Support appeals, reconsiderations, and peer-to-peer review coordination for denied authorization requests
- Assist with reporting, performance metrics, and quality improvement initiatives related to authorization turnaround times and payer performance
Licenses / Qualifications
- High school diploma or equivalent required
- Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Health Information Management, or a related field preferred
- Ability to successfully complete required background and reference checks
Experience
- Minimum of 1–2 years of experience in healthcare prior authorizations, utilization management, admissions, intake coordination, or insurance verification
- Experience supporting Residential Recovery Programs (RRP), Substance Use