Authorization Specialist

• Verify benefits and eligibility prior to admission and throughout treatment
• Complete pre-certifications, concurrent reviews, and re-certifications for PHP/IOP levels of care
• Obtain Single Case Agreements with out-of-network payers
• Build the medical necessity case using ASAM, LOCUS, and CALOCUS criteria
• Prepare and submit appeals on denied authorizations
• Maintain accurate, audit-ready authorization, denial, and SCA records

Behavioral Health UR/Authorization Specialist managing insurance authorization for mental health programs

Behavioral Health UR/Authorization Specialist

Behavioral Health UR/Authorization Specialist managing insurance authorizations for PHP and IOP programs. Ensuring client access to treatment by handling pre-certifications and appeals.

• Obtain and maintain prior authorization status for NELC patient medications/therapies
• Work closely with the clinical review department to obtain documentation needed to complete the authorization process
• Obtain needed documentation to support the billing department in meeting payer requirements for patient accounts

Authorization Specialist obtaining patient medication authorizations for home infusion provider

Remote Authorization Specialist for New England Life Care seeking to obtain patient medication authorizations and support billing processes. Requires 3 years authorization or billing experience in specified US states.

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Behavioral Health UR/Authorization Specialist

Authorization Specialist