Benefits &Prior Authorization Specialist

• Location 29125 Chagrin Blvd,Pepper Pike, OH, 44122,United States
• Base Pay $26.00 / Hour
• Job Category HR Review, Staff
• Employee Type FTE .75-1.0
• Required Degree High school
• Manage Others No

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, or incomplete 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.

Minimum Qualifications and Skills:

• High School Diploma/GED, degree in healthcare administration, information management, medical billing and coding, business, or related behavioural health field preferred.
• Relevant payer, clinical expereince, prior authorization, revenue-cycle, or medical office training may substitute for post-secondary education.
• Experience in Excel, Word, and other applicable software.
• At least 2 years expereince in healthcare prior authorization, insurance verification, utilization support, medical billing, revenue cycle, or medical office operation is preferred.
• Behavioral health, community mental health Medicaid managed care, or human-services expereince is strongly preferred.
• Excellent interpersonal skills.
• Must be able to prioritize and schedule daily activities effectively.
• High degree of accuracy and attention to detail.
• Experience using the Internet.
• Experience with payer portals, authorizations, claims-tracking systems, Direct Data Entry (“DDE”), and electronic medical records systems preferred.

Jewish Family Service Association of Cleveland is an Equal Opportunity Employer with a strong commitment to diversity, inclusion, and equity. In accordance with applicable law, we prohibit discrimination against any applicant or employee based on any legally-recognized basis, including, but not limited to: race, color, religion, sex (including pregnancy, lactation, childbirth, or related medical conditions), sexual orientation, gender identity, age (40 and over), national origin or ancestry, ethnic group, citizenship status, physical or mental disability, genetic information (including testing and…