PRP Authorization Coordinator (In-office)

Job Summary: We are seeking an experienced PRP Authorization coordinator to join our starting off PRP Adult Program.

The ideal candidate will be responsible for obtaining/handling PRP referrals and completing authorizations on Carelon.

Please note that this is an in-office position for 20 hours a week.

Duties:

- Work closely with the PRP Admin Staff, and PRP Specialist (CPRP- Adult) handling and obtaining authorizations for PRP approval for Medicaid clients that has the required necessity to be in the program.

- Communicate with the program director and PRP specialist to resolve authorization issues- Maintain accurate and up-to-date records of authorizations and communications- Collaborate with program director, PRP specialist to ensure proper documentation for authorization submissions on Carelon. Follow through with authorizations and notify the Program director.

-Must have knowledge of share point or willing to learn share point to update authorization status etc

Qualifications:- Proficiency in medical terminology, coding (ICD-9, ICD-10) and previous experiences with PRP authorizations on Incedo or related field- Knowledge of HIPAA regulations and compliance standards

- Familiarity with Carelon, understand PRP, and Medicaid insurance processes

- Strong organizational skills with attention to detail

- Ability to work effectively in a fast-paced environment

Nice-to-Have Skills:- Experience working in a OMHC/PRP programs

PRP (Psychiatric Rehabilitation Program) Authorization responsibilities and qualifications:

Job Description:

Role Overview: The PRP Authorization Coordinator is responsible for collaborating and managing the authorization process for our Adult psychiatric rehabilitation services. He/She will ensure that all required documentation and criteria are met to secure authorization for PRP services via Carelon.

Responsibilities:

• Authorization Management:
• Review and process authorization requests for PRP services.
• Ensure all required documentation is complete and accurate before submission.
• Coordinate with PRP team (Program Director, and PRP specialist CPRP), clients, and PRP admin support to obtain necessary information for authorizations.
• Track and monitor authorization status to ensure timely approvals.
• Documentation and Compliance:
• Maintain thorough and organized records of authorization requests and approvals.
• Ensure compliance with insurance company guidelines and regulations regarding PRP service authorizations.
• Update and maintain databases or systems such as share point, carelon, and google workspace used for tracking authorization processes.
• Communication and Coordination:
• Collaborate with clinical PRP staff to gather necessary clinical documentation for authorization submissions.
• Provide support and guidance to clients and their families regarding authorization processes and requirements.
• Quality Assurance:
• Participate in quality assurance activities related to authorization processes.
• Identify opportunities for process improvement and efficiency in authorization procedures.
• Ensure adherence to organizational policies and procedures related to PRP authorization.

Qualifications:

• Experience in PRP program, Authorization knowledge via Incedo or Carelon is a plus, and insurance authorization processes.
• Knowledge of Carelon is a MUST
• Strong organizational skills with attention to detail.
• Excellent communication and interpersonal skills.
• Ability to work effectively in a team environment and independently.

Job Type: Part-time

Pay: $22.00 - $25.00 per hour

Expected hours: 20 per week

Benefits:

• Paid time off

Work Location: In person

Salary : $22 - $25