OMHCFGC Prior Authorization Specialist

This a Philippine-based position;

NOT a US based position and the pay rate is not in US currency.

ABOUT FREEDOM HEALTH SYSTEMS INC:

Freedom Health Systems Inc. is a mission-driven healthcare advisory and management consulting firm that partners with behavioral health and human services organizations to improve access equity and operational excellence. We specialize in guiding providers through program development accreditation compliance and clinical best practicesempowering them to deliver high-quality person-centered care to their communities.

While we do not provide direct healthcare services Freedom Health Systems plays a vital role behind the scenes by strengthening organizational infrastructure supporting service expansion and helping our partners lead with innovation and integrity. Our expertise spans a wide range of operational services including revenue cycle management prior authorization virtual front office support medical billing and coding human resources and compliance consulting.

At Freedom Health Systems we are deeply committed to breaking down barriers in the behavioral health space with a particular focus on serving marginalized and underserved populations. Our team fosters a collaborative forward-thinking work environment where every employee contributes to advancing impactful community-based care.

DISCLOSURES:

The specific statements shown in each section of this job description are not intended to be all-inclusive. They represent typical elements and criteria considered necessary to perform the job successfully. The jobs responsibilities/tasks may be modified and/or expanded over time. Company will inform the personnel member when changes in the respective job description are made.

COMPANY WEBSITE:

COMPANY PHONE NUMBER:

HUMAN RESOURCES DEPARTMENT PHONE NUMBER: EXT 10

HUMAN RESOURCES DEPARTMENT EMAIL ADDRESS:

POSITION TITLE: OMHC/FGC Prior Authorization Specialist

ALTERNATE TITLE(S): PA Coordinator Authorization & Intake Coordinator

COMPANY: Freedom Health Systems Inc. (in support of all customer companies under contract)

DIVISION: Accounting & Finance

DEPARTMENT: Accounts Receivables

UNIT: Prior Authorization

BENEFITS PACKAGE: Ineligible.

WORK SCHEDULE: Monday Friday 8:00 AM EST 5:00 PM EST

ACCOUNTABLE TO: Prior Authorization Unit Supervisor (Accounts Receivables Department Manager in the absence of the Prior Authorization Unit Supervisor)

ACCOUNTABLE FOR: Timely and accurate submission of authorization requests and intake coordination for OMHC and FGC clients

CLASSIFICATION: W8BEN

COMPENSATION RANGE: 283.63 PHP per hour (this is not USD)

ANTICIPATED TRAVEL: none

SUMMARY OF POSITION RESPONSIBILITIES:

The OMHC/FGC Prior Authorization Specialist is responsible for coordinating the intake and authorization process for clients referred to Community Wellness Outpatient Mental Health Center and Freedom Healthcare Primary Care Freestanding General Clinic. This includes ensuring all medical necessity documentation is complete submitting timely prior authorizations tracking approvals and maintaining records in compliance with payer requirements.

This role ensures that all clients are fully authorized for services at least three (3) business days prior to their scheduled start date minimizing service disruptions and maximizing reimbursement potential.

SCHEDULED DUTIES AND RESPONSIBILITIES:

• Collect and verify intake documentation for new clients referred to OMHC and FGC programs
• Review insurance requirements and authorization timelines for each payer
• Prepare submit and track initial and continuing authorizations in compliance with MCO or Medicaid requirements
• Monitor authorization expiration dates and initiate renewal requests proactively
• Communicate with providers and clinical staff to obtain missing information or signatures
• Update EHR systems and internal trackers with status of each authorization
• Ensure all intake and authorization tasks are completed within internal timelines including 3-day minimum prior to service
• Notify clinical and scheduling departments of authorization approvals or delays
• Support intake calls and triage referral inquiries as needed
• Maintain organized electronic records for audit readiness and compliance
  

UNSCHEDULED DUTIES AND RESPONSIBILITIES:

• Assist your supervisor with any work-related tasks as requested taking initiative where possible
• Remain informed and compliant with regulations and standards including COMAR CARF and other relevant governing bodies as well as company policies and procedures
• Support the maintenance of a safe work environment by participating in drills and safety trainings as requested
• Maintain confidentiality of all records especially those relating to client treatment or financial information
• Participate in external and internal audits/surveys (CARF/CSA/OHCQ) as directed by the supervisor
• Contribute to quality assurance and performance improvement plans by conducting audits and activities that ensure regulatory compliance
  
• Assist with insurance verifications and benefit checks during high volume periods
• Participate in weekly prior authorization team meetings and cross-training sessions
• Cover for other team members during absences or program needs
• Contribute to quality improvement initiatives related to authorization turnaround times or documentation standards
• Support data collection and reporting for compliance or payer audits
  

PHYSICAL DEMANDS:

• Prolonged periods sitting at a desk and working on a computer
• Frequent meetings via video or phone; occasional in-person site visits

WORKING CONDITIONS:

• Remote
• Fast-paced deadline-driven environment with collaborative teams
  

COMPETENCIES AND SKILLS:

• Knowledge of Maryland Medicaid and MCO prior authorization processes
• Understanding of outpatient mental health and behavioral health terminology
• Attention to detail and ability to manage multiple open requests
• Excellent time management and follow-up tracking
• Strong written and verbal communication
• Proficiency in EHR and payer portal navigation
  

LEVEL OF EDUCATION / TRAINING / QUALIFICATIONS:

• High school diploma or equivalent (required); Associates or Bachelors degree preferred
• Minimum 12 years of experience in healthcare administration authorizations or intake coordination
• Experience with behavioral health OMHC or PRP authorizations preferred
• Ability to pass background and reference checks
  

Required Experience:

Manager