Prior Authorization Specialist

The Remedy•White Bear Lake, MN

1d•$25 - $26•Onsite

About The Position

At The Remedy, the Prior Authorization Specialist plays an integral role in the patient intake and revenue cycle process. This role will focus on the coordination and management of medication and treatment prior authorizations for a mental health organization, ensuring accuracy, timely submission, and alignment with payer guidelines to support uninterrupted patient care. This role leverages expertise in insurance verification and authorization processes to confirm benefits and eligibility, collect necessary documentation, and submit prior authorization requests to support timely and accurate reimbursement. This is an onsite position based in Vadnais Heights, MN.

Requirements

Excellent verbal and written communication skills.
Strong interpersonal, negotiation, and conflict resolution skills.
Exceptional organizational skills with strong attention to detail.
Strong analytical and problem-solving abilities.
Ability to prioritize tasks effectively.
Demonstrated integrity, professionalism, and ability to maintain confidentiality.
Proficiency in Microsoft Office Suite and healthcare systems (PM/EMR preferred).
High school diploma or equivalent required.
1–3 years of experience in prior authorization, insurance verification, or revenue cycle operations required.
Familiarity with commercial and government payers (e.g., Medicare, Medicaid) required.
All candidates must be legally authorized to work in the United States. The company does not currently sponsor employment visas.

Nice To Haves

Associate’s or Bachelor’s degree in healthcare administration or related field preferred.
Experience working with behavioral health services strongly preferred.
Experience using PM/EMR systems and payer portals (e.g., Availity or similar) preferred

Responsibilities

Educates patients prior to appointments on their benefits, including differences between medical and behavioral health coverage, to support informed treatment decisions.
Contacts payers to verify insurance benefits and eligibility for behavioral health services via online portals, eligibility systems, or direct communication.
Ensures all benefit information is accurately documented to reduce rework and support clean claim submission.
Requests and collects required clinical documentation from providers to support authorization approvals.
Prepares and submits prior authorization requests to commercial and government payers.
Organizes patient medical records for prior authorization and appeals processes as needed.
Tracks and monitors the status of prior authorization requests and appeals, documenting updates in PM/EMR systems.
Posts payer authorization decisions in a timely and accurate manner prior to services to ensure financial clearance, enhance patient experience, and support timely reimbursement.
Identifies and reports payer trends or patterns impacting authorizations.
Communicates proactively with patients to provide updates and address questions throughout the authorization process.
Performs other duties as assigned.
Serve as a liaison between providers, patients, and internal departments, facilitating clear communication to support accurate workflows and positive patient outcomes.