RCM Authorization Specialist

GeBBS Healthcare Solutions is a provider of Revenue Cycle Management (RCM) and Risk Adjustment services for healthcare organizations. The company focuses on improving operations, financial performance, compliance, and patient experience through technology and industry expertise.

This role supports prior authorization, eligibility verification, concurrent review, denials management, and payer coordination for behavioral health services in a remote U.S.-based setting.

Responsibilities

• Initiate, submit, and track prior authorization requests across commercial and managed care payers.
• Verify patient eligibility and benefits before submission and confirm coverage, plan requirements, authorization thresholds, deductibles, copays, and related benefit details.
• Ensure authorization requests include complete and accurate demographic, clinical, and supporting documentation.
• Monitor pending requests through payer portals and direct payer communication, following up through resolution.
• Document authorization numbers, approved services, CPT codes, effective dates, expiration dates, session or visit limits, and other payer requirements.
• Manage concurrent review, continued stay, and authorization renewal requirements for ongoing services.
• Track authorization limits and expiration dates and initiate renewals before authorizations are exhausted.
• Maintain accurate authorization records and communicate pending or expiring authorizations to operational and clinical teams.
• Review authorization-related denials and determine whether the cause is clinical, administrative, eligibility-related, or procedural.
• Coordinate corrective action and appeal activity within payer deadlines.
• Prepare appeal documentation and coordinate with clinical and operational teams to obtain supporting information when needed.
• Track appeals through resolution and maintain documentation of outcomes.
• Identify recurring denial trends and escalate systemic payer or process issues.
• Serve as a resource for payer authorization requirements, policies, portals, and workflows.
• Coordinate with billing, intake, clinical, credentialing, and contracting teams to resolve authorization-related reimbursement barriers.
• Support single-case agreements, out-of-network authorization requests, and other payer authorization functions as needed.
• Assist with payer audits and utilization management reviews by providing authorization records and supporting documentation.
• Maintain accurate and timely authorization activity within EHR, practice management, and tracking systems.
• Maintain payer authorization matrices and workflow documentation.
• Track authorization performance, including approval rates, denial rates, appeal outcomes, turnaround times, and outstanding requests.
• Recommend workflow improvements that strengthen revenue integrity and reduce preventable denials.
• Maintain compliance with HIPAA and applicable privacy and confidentiality requirements.