Prior Authorization Specialist

About this role

This role is responsible for driving the foundational stages of the reimbursement cycle by managing initial and mid-stay authorizations, payor notifications, and daily billing system triaging. Securing timely authorizations and maintaining precise documentation is a critical step in the financial process, directly preventing coverage gaps and administrative denials. By proactively managing these worklogs, this specialist ensures steady revenue flow, minimizes financial risk during a client's treatment stay, and protects the organization’s ability to get reimbursed for services.

Our team is composed of passionate, forward-thinking professionals eager to take on the challenge of the mental health crisis and play a formative role in providing life-saving solutions. We are looking for a candidate who is inspired by our mission and excited by the opportunity to build a business that will impact millions of lives in a profound way.

Responsibilities 

• Submitting initial authorization requests and tracking progress through final payor outcome to ensure coverage is active prior to service delivery.
• Managing and submitting new policy authorization requests for active clients who experience a change in coverage mid-treatment stay.
• Issuing timely notifications of non-admission to specific payors to remain compliant with strict contractual notice requirements.
• Triaging and prioritizing daily worklog tasks within the RCM billing system to resolve bottlenecks and keep claims moving forward.
• Executing ad hoc authorization and billing tasks as directed by management to support general department workflows and revenue capture.

Requirements

• 2–3 years of related work experience in healthcare administrative roles, specialized billing, prior authorizations, insurance verification, or claims management
• Strong knowledge of prior authorization processes, payor portals, and medical medical billing practices
• Proficiency with RCM billing systems and workflow triaging to effectively navigate and manage daily electronic task queues
• Knowledge of all confidentiality requirements (HIPAA) regarding patients and strict maintenance of proper confidentiality on all such information
• Excellent written and verbal communication skills for professional and persistent correspondence with insurance payors
• Strict attention to detail to ensure complex authorization timelines, dates of service, and policy numbers are accurately recorded
• Strong organizational and time-management skills to balance multiple mid-stay policy changes and time-sensitive payor notifications simultaneously
• Able to work a hybrid schedule of 4 days/week in our Nashville office and located within 75 minutes' commuting distance of the office

Benefits

Charlie Health is pleased to offer comprehensive benefits to all full-time, exempt employees. Read more about our benefits here. #LI-HYBRID