Behavioral Health Specialist

The Behavioral Health Specialist is responsible for managing incoming prior authorization and inpatient admission requests for behavioral health services. This role involves reviewing submissions, gathering clinical documentation from providers, verifying member eligibility, and data entry.

• Manages and prioritizes incoming behavioral health authorization and inpatient admission requests; processes designated services in accordance with departmental protocols
• Verifies member eligibility and enters all required data into the Jiva system
• Communicates with healthcare providers to request, clarify, or follow up on clinical information necessary for authorization determinations.
• Consistently meets or exceeds productivity benchmarks while maintaining compliance
• Notifies providers of authorization decisions, addresses escalated provider inquiries, and ensures clear, professional, and timely communication at all times.
• 3+ years of Behavioral Health experience, AA or BA/BS