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 proper routing to the clinical team while maintaining compliance with turnaround time standards.

Key responsibilities:

• Processes and prioritizes behavioral health authorization requests and inpatient admissions, ensuring adherence to departmental protocols
• Verifies member eligibility and accurately enters data into the Jiva system to comply with turnaround time standards
• Communicates with healthcare providers to gather necessary clinical information for authorization determinations and addresses escalated inquiries

Required qualifications:

• Associate's Degree in Healthcare, Nursing, Social Work, or a related area, or equivalent training and experience
• Minimum of 2 years of experience in a high-volume healthcare office, hospital administration, data entry office, or customer service call center
• Familiarity with Jiva, FACETS, or other healthcare databases is preferred
• Previous experience in health plan utilization or claims processing is desirable
• Pre-employment background check required