PRP Prior Authorization Specialist

Baltimore, MD - Remote

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

Enterprise Management Solutions, LLC (EMS) is a full-spectrum consulting and management firm specializing in back-office operations, financial infrastructure, and executive oversight for health and human services organizations. We provide strategic support to affiliated companies through contractual partnerships, optimizing operations and maintaining compliance across multiple industries including behavioral health, primary care, real estate, supportive housing, and food service.

Our goal is to relieve mission-driven companies of administrative burden by overseeing financial and operational systems that allow leadership teams to focus on quality care and innovation.

COMPANY WEBSITE:

COMPANY PHONE NUMBER: (667) 309-5345

HR DEPARTMENT PHONE NUMBER: (667) 400-6206 EXT 10

HR DEPARTMENT EMAIL ADDRESS:

POSITION TITLE: PRP Prior Authorization Specialist

ALTERNATE TITLE(S): PA Coordinator, Authorization & Intake Coordinator

COMPANY: Enterprise Management Solutions, LLC

DIVISION: Accounting & Finance

DEPARTMENT: Accounts Receivables

UNIT: Prior Authorization

ACCOUNTABLE TO: Prior Authorization Unit Supervisor (Accounts Receivables Department Manager in the absence of the Prior Authorization Unit Supervisor)

ACCOUNTABLE FOR: Timely and accurate submission of authorization requests and intake coordination for PRP clients

CLASSIFICATION: Exempt – Independent Contractor (Non-U.S., W-8BEN)

WORK SCHEDULE: This schedule reflects 8 hours per day, totaling 40 hours per week, Monday through Friday, 8:00 AM–5:00 PM. Scheduling needs may vary based on business demands, and adjustments may be required as reasonably assigned.

COMPENSATION RANGE: $4.50 - $6 USD per hour

ANTICIPATED TRAVEL: N/A

SUMMARY OF POSITION RESPONSIBILITIES

The PRP (Psychiatric Rehabilitation Program) Prior Authorization Specialist is responsible for coordinating the intake and authorization process for clients referred to Community Wellness Outpatient Psychiatric Rehabilitation Program and the Behavioral Health Home. This includes ensuring all medical necessity documentation is complete, submitting timely prior authorizations, tracking approvals, and maintaining records in compliance with payer requirements.

This role ensures that all clients are fully authorized for services at least three (3) business days prior to their scheduled start date, minimizing service disruptions and maximizing reimbursement potential.

SCHEDULED DUTIES AND RESPONSIBILITIES

• Collect and verify intake documentation for new clients referred to PRP 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 Managed Care Organization (MCO) authorization processes
• Understanding of Psychiatric Rehabilitation Program (PRP) services and behavioral health terminology
• Strong attention to detail and organizational skills
• Excellent time management and ability to manage multiple authorization requests simultaneously
• Strong written and verbal communication skills
• Proficiency using Electronic Health Records (EHR), payer portals, and related software
• Ability to work independently while collaborating effectively with cross-functional teams
• Strong problem-solving and follow-up skills
• Commitment to confidentiality, accuracy, and regulatory compliance
• Ability to perform effectively in a fast-paced, deadline-driven remote environment

LEVEL OF EDUCATION / TRAINING / QUALIFICATIONS

Education

• High school diploma or equivalent required
• Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred

Certifications

• Must possess at least one recognized certification in Prior Authorization.
• And/or at least one recognized certification in Medical Billing and Coding.

Experience

• 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

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