Prior Authorization Specialist

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EMS

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1964

💊 Pharmaceuticals

⚕️ Healthcare Insurance

🧘 Wellness

Pharmaceuticals • Healthcare Insurance • Wellness

EMS is the largest pharmaceutical laboratory in Brazil, recognized for its commitment to providing effective and affordable health solutions. With over 55 years in the industry, EMS operates in more than 40 countries and offers a diverse portfolio of products, including innovative treatments for chronic conditions such as obesity and diabetes. The company also emphasizes social responsibility and quality, investing in research and development to ensure high standards in the medications it produces.

📋 Description

• Collect, review, and verify intake documentation for new PRP referrals • Review payer requirements and authorization timelines for Maryland Medicaid and Managed Care Organizations (MCOs) • Prepare, submit, monitor, and track initial and continuing prior authorization requests • Monitor authorization expiration dates and proactively initiate renewal requests • Coordinate with providers and clinical staff to obtain missing documentation, signatures, or supporting clinical information • Update electronic health records (EHR) and internal tracking systems with authorization status and required follow-up • Ensure all authorization requirements are completed at least three (3) business days prior to scheduled service delivery • Notify scheduling and clinical departments regarding authorization approvals, denials, delays, or pending requests • Support intake coordination and respond to referral inquiries as assigned • Maintain organized electronic authorization records to support audits and regulatory compliance • Assist with insurance eligibility verification and benefit reviews during high-volume periods • Participate in weekly authorization meetings, cross-training, and workflow improvement initiatives • Support quality assurance activities, payer audits, compliance reviews, and performance improvement projects • Provide coverage for other authorization team members during absences or operational needs • Maintain confidentiality of client and organizational information in accordance with HIPAA and company policies

🎯 Requirements

• 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 • Minimum of 1–2 years of experience in healthcare administration, prior authorization, medical intake, or insurance verification • Experience supporting behavioral health, Psychiatric Rehabilitation Programs (PRP), or outpatient mental health services preferred • Experience working with Maryland Medicaid, Managed Care Organizations (MCOs), or behavioral health payer requirements preferred • Experience using Electronic Health Record (EHR) systems and payer portals preferred

🏖️ Benefits

• Not eligible (Independent Contractor position)