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RRP Prior Authorization Specialist
Baltimore, MD - Remote
DISCLOSURES
The specific statements shown in each section of this job description are not intended to be all-inclusive. They represent typical elements and criteria necessary to perform the job successfully. Job responsibilities may be modified or expanded over time, and the company will inform the contractor of any such changes.
ABOUT THE COMPANY
Enterprise Management Solutions, LLC (EMS) is a full-spectrum consulting and management firm specializing in back-office operations, financial infrastructure, and executive oversight for health and human services organizations. We provide strategic support to affiliated companies through contractual partnerships, optimizing operations and maintaining compliance across multiple industries including behavioral health, primary care, real estate, supportive housing, and food service.
Our goal is to relieve mission-driven companies of administrative burden by overseeing financial and operational systems that allow leadership teams to focus on quality care and innovation.
COMPANY WEBSITE:
COMPANY PHONE NUMBER: (667) 309-5345
HR DEPARTMENT PHONE NUMBER: (667) 400-6206 EXT 10
HR DEPARTMENT EMAIL ADDRESS:
POSITION TITLE: RRP (Residential Recovery Program) Prior Authorization Specialist
ACCOUNTABLE TO: Prior Authorization Unit Supervisor (Accounts Receivables Department Manager in the absence of the Prior Authorization Unit Supervisor)
ACCOUNTABLE FOR: Timely and accurate submission of authorization requests and intake coordination for Residential Recovery Program (RRP) clients.
WORK SCHEDULE: This schedule reflects 8 hours per day, totaling 40 hours per week, Monday through Friday, 8:00 AM–5:00 PM. Scheduling needs may vary based on business demands, and adjustments may be required as reasonably assigned.
COMPENSATION RANGE: $4.50 - $6 USD per hour
ANTICIPATED TRAVEL: N/A
SUMMARY OF POSITION RESPONSIBILITIES
This role ensures that all clients receive the required authorization before admission or continuation of Residential Recovery Program services, helping prevent delays in treatment, ensuring regulatory compliance, and maximizing reimbursement opportunities.
SCHEDULED DUTIES AND RESPONSIBILITIES Collect and verify intake documentation for new 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 Recovery Program services.
Monitor authorization expiration dates and proactively submit reauthorization requests before coverage lapses.
Coordinate with clinical staff to obtain assessments, treatment plans, physician orders, and other supporting documentation required by payers.
Communicate with Medicaid Managed Care Organizations (MCOs), commercial insurance carriers, and other payers regarding authorization status.
Update the Electronic Health Record (EHR) and internal authorization tracking systems with current authorization information.
Ensure all authorization requests are completed within established timelines to prevent interruptions in residential services.
Notify admissions, clinical, billing, and program staff of authorization approvals, denials, or requests for additional information.
Maintain complete and organized electronic documentation for regulatory compliance, payer audits, and internal quality reviews.
Assist with client admissions by coordinating authorization-related requirements prior to admission.
Escalate authorization denials or urgent cases to the appropriate clinical or supervisory staff for timely resolution.
UNSCHEDULED DUTIES AND RESPONSIBILITIES Assist your supervisor with work-related assignments and special projects as requested.
Remain informed and compliant with applicable regulations, including COMAR, CARF, Medicaid requirements, and company policies.
Participate in quality assurance, utilization management, and performance improvement initiatives.
Maintain confidentiality of all client, financial, and organizational information in accordance with HIPAA and company policies.
Participate in internal and external audits, including CARF, CSA, OHCQ, Medicaid, and payer reviews.
Assist with insurance eligibility verification and benefit reviews during periods of high referral volume.
Participate in weekly authorization, admissions, and interdisciplinary team meetings.
Cross-train and provide coverage for other authorization specialists as needed.
Support appeals, reconsiderations, and peer-to-peer review coordination for denied authorization requests.
Assist in developing and maintaining authorization workflows, documentation standards, and performance metrics.
Support data collection and reporting related to authorization turnaround times, denial rates, payer trends, and compliance initiatives.
PHYSICAL DEMANDS: Prolonged periods sitting at a desk and working on a computer and frequent meetings via video or phone; occasional in-person site visits WORK CONDITIONS Remote Fast-paced, deadline-driven environment with collaborative teams COMPETENCIES AND SKILLS Knowledge of Maryland Medicaid, Managed Care Organizations (MCOs), and behavioral health authorization requirements.
Understanding of Residential Recovery Program (RRP), substance use disorder (SUD), behavioral health, and residential treatment terminology.
Strong knowledge of prior authorization, utilization management, and medical necessity documentation.
Excellent organizational skills with the ability to manage multiple concurrent authorization requests.
Strong attention to detail and follow-through.
Excellent written and verbal communication skills.
Ability to work independently while collaborating with multidisciplinary teams.
Experience navigating Electronic Health Records (EHRs), payer portals, and Microsoft Office applications.
Ability to analyze payer requirements and resolve authorization issues efficiently.
LEVEL OF EDUCATION / TRAINING / QUALIFICATIONS Education 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.
Experience Minimum of 1–2 years of experience in healthcare prior authorizations, utilization management, admissions, intake coordination, or medical insurance verification.
Experience supporting Residential Recovery Programs (RRP), Substance Use Disorder (SUD) treatment, behavioral health, residential treatment facilities, or similar healthcare settings strongly preferred.
Working knowledge of Maryland Medicaid and Managed Care Organization (MCO) authorization requirements preferred.
Experience using Electronic Health Records (EHR), payer portals, and Microsoft Office applications.
Salary: $4.50 - $6 USD per hour Originally posted on Himalayas
