PRP/BHH Prior Authorization Specialist

This a Philippine-based position;

NOT a US based position and the pay rate is not in US currency.

ABOUT FREEDOM HEALTH SYSTEMS, INC:

Freedom Health Systems, Inc. is a mission-driven healthcare advisory and management consulting firm that partners with behavioral health and human services organizations to improve access, equity, and operational excellence. We specialize in guiding providers through program development, accreditation, compliance, and clinical best practices—empowering them to deliver high-quality, person-centered care to their communities. We do not provide direct healthcare services; we strengthen organizational infrastructure, support service expansion, and help our partners lead with innovation and integrity. Our expertise spans revenue cycle management, prior authorization, virtual front office support, medical billing and coding, human resources, and compliance consulting. We are committed to breaking down barriers in the behavioral health space, with a focus on serving marginalized and underserved populations in a collaborative, forward-thinking work environment.

Note: The following disclosures, statements, and contact information are provided for context within this job description and may be updated by the company as needed.

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 considered necessary to perform the job successfully. The job’s responsibilities/tasks may be modified and/or expanded over time. Company will inform the personnel member when changes in the respective job description are made.

COMPANY WEBSITE: Freedom Health Systems, Inc. —

COMPANY PHONE NUMBER:

HUMAN RESOURCES DEPARTMENT PHONE NUMBER: EXT 10

HUMAN RESOURCES DEPARTMENT EMAIL ADDRESS:

POSITION

PRP/BHH Prior Authorization Specialist

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

COMPANY: Freedom Health Systems, Inc. (in support of all customer companies under contract)

DIVISION: Accounting & Finance

DEPARTMENT: Accounts Receivables

UNIT: Prior Authorization

BENEFITS PACKAGE: Ineligible.

WORK SCHEDULE: Monday – Friday, 8:00 AM EST – 5:00 PM EST

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 and BHH clients

CLASSIFICATION: W8BEN

COMPENSATION RANGE: ₱340.35 PHP per hour (this is not USD)

ANTICIPATED TRAVEL: None

SUMMARY OF POSITION RESPONSIBILITIES

The PRP/BHH 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.

RESPONSIBILITIES

Scheduled duties and responsibilities:

• Collect and verify intake documentation for new clients referred to PRP and BHH 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
• Frequent meetings via video or phone; occasional in-person site visits

WORKING 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

• High school diploma or equivalent (required); Associate’s or Bachelor’s degree preferred
• Minimum 1–2 years of experience in healthcare administration, authorizations, or intake coordination
• Experience with behavioral health, OMHC, or PRP authorizations preferred
• Ability to pass background and reference checks

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