Behavioral Health Specialist

Job Summary

Managing incoming prior authorization and inpatient admission requests for behavioral health services, the full-time remote Behavioral Health Specialist will review submissions, gather clinical documentation, verify member eligibility, and ensure timely communication of determinations while collaborating with the clinical team.

Key responsibilities:

• Manages and prioritizes behavioral health authorization and admission requests, routing cases to the clinical team as needed
• Verifies member eligibility and accurately enters data into the Jiva system to comply with turnaround time standards
• Communicates with healthcare providers to obtain necessary clinical information for authorization determinations

Required qualifications:

• Associate's Degree in Healthcare, Nursing, Social Work, or a related area, or equivalent training and experience
• A minimum of 2 years of experience in a high-volume healthcare office, hospital administration, or customer service call center
• Knowledge of medical terminology is preferred
• Familiarity with Jiva, FACETS, or other healthcare databases is desirable
• Previous experience in health plan utilization or claims processing is a plus