Pre-Authorization Specialist

Stephen Center has served homeless and low-income individuals in Omaha since
1984 with the mission to partner with the community, families and individuals to overcome homelessness, addiction and poverty. The Pettigrew Emergency Shelter and Permanent Supportive Housing offerings provide safe and secure housing while individuals and families complete an assessment of permanent housing options. All Stephen Center residents have access to dual diagnosis support services via the HERO addiction/recovery program. 100% of Stephen Center shelter supportive housing participants are living in poverty.

Housing transition support identifies poverty barriers that may impact one’s ability to achieve or maintain permanent housing through case management, life skills, and behavioral health services. Stephen Center serves approximately 250 people daily in all programs.

Purpose:

The primary purpose of the Pre-Authorization Specialist is to obtain prior authorizations from Nebraska Medicaid to ensure timely reimbursement for services provided within the HERO program. This position works closely with counselors, case management, admissions coordinator, Medicaid/Insurance billing specialist, as well as the payors to submit proper authorization requests while maintaining compliance with payor requirements. This role requires strong communication skills as it is client-facing, and part of the responsibilities include having sensitive conversations with clients regarding their account balances and helping those clients understand how unpaid balances will impact their ability to graduate from the HERO program.

Key Accountabilities:

• Maintains comprehensive working knowledge of markets including government agencies, major payor groups, and key referral sources.
• Obtain prior authorizations for mental health and behavioral health services, including psychotherapy, and intensive services.
• Submit accurate and complete authorization requests via payor portals, phone, or fax.
• Communicate with counselors and case management to gather required documentation (clinical notes, orders, medical necessity).
• Track authorization approvals, denials, and expiration dates to ensure continuity of care.
• Assist with re-authorizations and concurrent reviews as needed.
• Document authorization details accurately in the electronic health record (EHR).
• Identify and resolve authorization denials, delays, or discrepancies.
• Stay current on insurance policies, payor rules, and authorization requirements.
• Accept cash or card payments from clients and report them to the Medicaid/Insurance Billing Specialist.
• Meet with clients, as necessary, to inform them of outstanding balances that will affect program completion.
• Assist with Monthly/Quarterly Billing Audits to help ensure we maintain timely and accurate billing.
• Additional responsibilities may be assigned.

Position Requirements:

• High school diploma or equivalent required; associate’s degree or higher preferred.
• Credit or non-credit courses in computer fundamentals and the application of basic office management software in the business setting.
• Strong work experience (preferably 1-3 years) in behavioral health pre-authorization, utilization management, or revenue cycle operations.
• Knowledge of mental health diagnoses, treatment modalities, and levels of care.
• Self-starter/manager.
• Team player with ability to job share.
• Excellent written, oral and interpersonal communication skills.
• Proficiency with PC applications specifically within Microsoft 365 (Outlook, Teams, Excel, Word).
• Strong organizational and time management skills.
• Ability to manage and coordinate multiple tasks and balance long and short-term projects simultaneously.
• Ability to work with staff quickly, accurately and effectively in a dynamic work environment.
• Commitment to the utmost confidentiality in the handling of all client activities, client records, files, etc.
• Conducts self in a manner of professionalism that is conducive to recovery from mental illness, co-occurring disorders and overall wellness. Abides by all specific program and Agency procedures, policies, and requirements.
• Work environment characteristics described here are representative of those that…