OMHC Prior Authorization Specialist

Enterprise Management Solutions, Inc.$4.50 – $6.00 per hourPhilippines only

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OMHC Prior Authorization Specialist
Baltimore, MD
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

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OMHC Prior Authorization Specialist at Enterprise Management Solutions, Inc. · ApplyPick

SCHEDULED DUTIES AND RESPONSIBILITIES Collect and verify intake documentation for new clients referred to OMHC programs Review insurance requirements and authorization timelines for each payer Prepare, submit, and track initial and continuing authorizations in compliance with MCO or Medicaid requirements Monitor authorization expiration dates and initiate renewal requests proactively Communicate with providers and clinical staff to obtain missing information or signatures Update EHR systems and internal trackers with status of each authorization Ensure all intake and authorization tasks are completed within internal timelines, including 3-day minimum prior to service Notify clinical and scheduling departments of authorization approvals or delays Support intake calls and triage referral inquiries as needed Maintain organized electronic records for audit readiness and compliance UNSCHEDULED DUTIES AND RESPONSIBILITIES Assist your supervisor with any work-related tasks as requested, taking initiative where possible Remain informed and compliant with regulations and standards, including COMAR, CARF, and other relevant governing bodies, as well as company policies and procedures Support the maintenance of a safe work environment by participating in drills and safety trainings as requested Maintain confidentiality of all records, especially those relating to client treatment or financial information Participate in external and internal audits/surveys (CARF/CSA/OHCQ) as directed by the supervisor Contribute to quality assurance and performance improvement plans by conducting audits and activities that ensure regulatory compliance Assist with insurance verifications and benefit checks during high volume periods Participate in weekly prior authorization team meetings and cross-training sessions Cover for other team members during absences or program needs Contribute to quality improvement initiatives related to authorization turnaround times or documentation standards Support data collection and reporting for compliance or payer audits 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 and MCO prior authorization processes Understanding of outpatient mental health and behavioral health terminology Attention to detail and ability to manage multiple open requests Excellent time management and follow-up tracking Strong written and verbal communication Proficiency in EHR and payer portal navigation LEVEL OF EDUCATION / TRAINING / QUALIFICATIONS Education High school diploma or equivalent (required); Associate’s or Bachelor’s degree preferred Experience Minimum 1–2 years of experience in healthcare administration, authorizations, or intake coordination Experience with behavioral health, OMHC, or PRP authorizations preferred Salary: $4.50 - $6 USD per hour Originally posted on Himalayas

OMHC Prior Authorization Specialist

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ABOUT THE COMPANY

OMHC Prior Authorization Specialist

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ABOUT THE COMPANY

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