Benefits &Prior Authorization Specialist

Do you have experience with healthcare prior authorizations, insurance verification, medical billing, electronic health records, payer portals, or Medicaid management? JFSA of Cleveland has an immediate opening for a part-time or full-time Benefits & Prior Authorization Specialist. Position Type: Hourly, Part-time or Full-time, Office-based General Duties and Responsibilities: Coordinates initial, concurrent, and renewal prior authorization requests for assigned behavioral health services in accordance with payer requirements and internal timelines.Verifies coverage, eligibility, benefit limitations, authorization requirements, and payer-specific submission procedures before services begin and throughout the authorization period.Advocates for individuals through benefits application/enrollment process. Monitors revalidation/redetermination needs through client portals or local office. Assists individuals with problem-solving barriers and ensuring benefits are reinstated. Reviews authorization packets for required administrative and clinical elements and promptly follows up on missing, inconsistent, expired, orincomplete information.Submits requests and supporting records through payer portals and other approved secure methods while protecting client confidentiality and complying with HIPAA requirements.Maintains an accurate authorization tracker that includes requested and approved services and units, effective dates, remaining balances, renewal deadlines, status, denials, and follow-up activity.Monitors service utilization, payer thresholds, and clients approaching or exceeding authorized limits and provides advance notice to clinical and program leadership.Tracks pending requests through final resolution, documents payer communications, responds to requests for additional information, and escalates delays before they affect services or billing.Coordinates prior authorization denial reviews, reconsiderations, peer-to-peer requests, and appeals by gathering records, communicating deadlines, and supporting clinical leadership and billing staff.Communicates authorization decisions and limitations promptly and ensures approved information is entered accurately in the electronic health record and billing systems.Reconciles authorization records with service delivery and claims data and helps identify services delivered without authorization, unused units, authorization-related denials, and recurring process gaps.Prepares routine reports on pending requests, upcoming expirations, denials, appeal outcomes, turnaround times, and authorization-related financial risk and recommends workflow improvements.Maintains organized, audit-ready records and remains current on Ohio Medicaid, managed care, Medicare, commercial payer, and organizational requirements relevant to assigned services.Participates in team meetings, audits, training, and quality-improvement activities and performs other duties or special projects as required or assigned.Credentialing new providers for in-network reimbursement and provider revalidations.Assists with special projects as needed and any additional duties as assigned.