RRP Prior Authorization Specialist

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🔥 21 minutes ago

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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

• Coordinate the prior authorization and intake process for clients entering or receiving services through the Residential Recovery Program (RRP) • Ensure all required authorizations are obtained before admission or continuation of residential treatment services • Prepare and submit authorization requests, monitor authorization status and renewals, maintain accurate documentation • Communicate with Medicaid Managed Care Organizations (MCOs), commercial insurers, and other payers • Maintain organized electronic documentation to support regulatory compliance, payer audits, and internal quality reviews • Escalate urgent cases, authorization denials, or complex payer issues to appropriate clinical or supervisory staff • Participate in authorization meetings, cross-training, workflow improvement initiatives, and utilization management activities

🎯 Requirements

• 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 • 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 Disorder (SUD) treatment, behavioral health, or residential treatment programs 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 preferred

🏖️ Benefits

• Not eligible (Independent Contractor position)