Who is Comprehensive Healthcare?
Comprehensive Healthcare provides innovative behavioral health and integrated healthcare services to clients of all ages. We take pride in our creative and collaborative work environment and in delivering clinically excellent, trauma-informed, recovery-oriented services.
What are we looking for in an Authorization & Referral Specialist?
The Authorization Specialist provides full-spectrum coordination of client referrals and obtainment, entry and tracking of authorizations in the electronic health record.
Authorization Specialist duties may include:
- Coordinates and manages prior authorizations across multiple programs within the organization.
- Participates in process improvement efforts related to authorization workflows and payer compliance.
- Reviews and interprets payer requirements to determine authorization necessity and coverage limitations prior to service delivery.
- Submits authorization requests with appropriate clinical documentation and ensures compliance with payer guidelines.
- Understands funding source requirements (i.e., Medicare, Medicaid, and private insurance).
- Performs detailed verification of insurance benefits and eligibility to support accurate authorization submission.
- Identifies and resolves discrepancies related to payer requirements, coverage, and authorization status.
- Monitors authorization timelines and proactively follows up to prevent delays or denials.
- Communicates payer requirements, authorization status, and coverage limitations to internal teams.
- Collaborates with clinical and administrative staff to ensure appropriate documentation supports medical necessity.
- Maintains current knowledge of Medicare, Medicaid, and commercial payer policies.
- Identifies potential financial liability scenarios and escalates as appropriate.
Qualifications:
- High school diploma or equivalent is required.
- Minimum one (1) year of experience in a healthcare setting required
- Minimum one (1) year of experience in insurance verification, prior authorizations, or healthcare revenue cycle functions required.
Preferred qualifications:
- Two (2) to three (3) years of experience in healthcare, authorizations, or utilization management strongly preferred. Knowledge of Medicare, Medicaid, and commercial insurance payer requirements.
- Experience working with prior authorizations across multiple service lines or programs.
- Ability to interpret insurance benefits, coverage limitations, and authorization requirements.
- Experience with electronic health records (EHR) and payer portals.
- Understanding of coordination of benefits and payer hierarchy
- Strong attention to detail and ability to analyze and resolve payer-related issues.
What Comprehensive Healthcare Can Offer You
Training and Development
- A variety of career opportunities in a wide range of settings with room for mobility and promotion
- Regular training opportunities including support, supervision, and consultation in implementing evidence-based services and programs
Innovative Program & Services
- A strong reputation for providing quality, evidence-based services within a collaborative multi-disciplinary team environment
- Innovative, forward-looking leadership that seeks to thrive in an ever-changing healthcare environment
- Joint Commission-accredited organization committed to continuous quality improvement
- Established partnerships with major research universities and other community and healthcare providers to implement cutting-edge treatment programs and services
Excellent Benefits
- Competitive salaries within our communities and industry
- Healthcare coverage for employee and qualified family members
- Generous vacation, paid holiday and sick leave policies
- Access to Employee Assistance Program services
- Agency-funded retirement plan with contributions equal to 5% of compensation
- Additional retirement investment opportunities with a 50% investment match of up to 4% of compensation
- Agency-funded life and disability insurance program
- Financial incentives to further employee education
Comprehensive Healthcare is proud to be an equal opportunity employer. We do not discriminate based on race, sex, age, color, religion, national origin, sexual orientation, gender identity or expression, marital status, veteran status, disability status, or any other basis prohibited by federal, state, or local law. We value the diverse perspectives and strengths that our employees bring to the workplace and we encourage individuals from underrepresented groups to apply for our positions.
Skills Required
- High school diploma or equivalent
- Minimum one (1) year of experience in a healthcare setting
- Minimum one (1) year of experience in insurance verification, prior authorizations, or healthcare revenue cycle functions
What We Do
Comprehensive Healthcare is a private nonprofit organization that offers a full range of mental health and substance use disorder treatment services, serving children, adults, and families.
