Prior Authorization Associate

Ensures that necessary approvals are obtained from insurance companies for Targeted Case
Management and IOP programs by liaising with qualified providers, staff and payers. Tracking the
authorization process daily. 

Key responsibilities include submitting requests to insurers, monitoring for approvals or denials, updating
patient records, and communicating with all TCM/IOP staff to facilitate timely care and revenue cycle
efficiency. 

Information Gathering: 
Collect and compile necessary clinical information from patients’ charts to support the authorization
request. 

Communication with Payers: 
Submit complete, timely, and accurate prior authorization requests to insurance companies and health
plans. 

Follow-up Management: 
Track the status of authorization requests, including appeals for denied requests, to ensure services
are approved. 

Liaise with Program coordinators: 
Act as a point of contact between referring providers and insurance companies, providing updates and
resolving issues. 

Data Entry and Documentation: 
Accurately enter and update patient and claim information in relevant locations

Issue Identification: 
Identify trends or issues in prior authorization that lead to delays in claim processing or patient care. 

Required Skills and Qualifications:

Communication: 
Strong verbal and written communication skills to interact with patients, providers, and insurance
companies. 

Attention to Detail: 
Meticulous attention to detail for accurately collecting and entering sensitive information. 

Organizational Skills: 
Ability to multitask and manage a high volume of requests and documentation. 

Computer Proficiency: 
Familiarity with healthcare billing systems, electronic health records (EHR), and general computer
skills. 

Insurance Knowledge: 
Understanding of Kentucky State insurance guidelines, managed care protocols, and prior
authorization processes. 

Experience: 
Previous experience in Behavioral Health medical billing /coding, or referral coordination preferred.