Prior Authorization Unit Supervisor

ABOUT FREEDOM HEALTH SYSTEMS, INC:

Freedom Health Systems, Inc. is a mission-driven healthcare advisory and management consulting firm that partners with behavioral health and human services organizations to improve access, equity, and operational excellence. We specialize in guiding providers through program development, accreditation, compliance, and clinical best practices-empowering them to deliver high-quality, person-centered care to their communities.

While we do not provide direct healthcare services, Freedom Health Systems plays a vital role behind the scenes by strengthening organizational infrastructure, supporting service expansion, and helping our partners lead with innovation and integrity. Our expertise spans a wide range of operational services, including revenue cycle management, prior authorization, virtual front office support, medical billing and coding, human resources, and compliance consulting.

At Freedom Health Systems, we are deeply committed to breaking down barriers in the behavioral health space, with a particular focus on serving marginalized and underserved populations. Our team fosters a collaborative, forward-thinking work environment where every employee contributes to advancing impactful, community-based care.

DISCLOSURES:

The specific statements shown in each section of this job description are not intended to be all-inclusive. They represent typical elements and criteria considered necessary to perform the job successfully. The job's responsibilities/tasks may be modified and/or expanded over time. Company will inform the personnel member when changes in the respective job description are made.

COMPANY WEBSITE: https://freedomhs.org

COMPANY PHONE NUMBER: 667-239-9572

HUMAN RESOURCES DEPARTMENT PHONE NUMBER: 667-239-9572 EXT 10

HUMAN RESOURCES DEPARTMENT EMAIL ADDRESS: info@freedomhs.org

POSITION TITLE: Prior Authorization Unit Supervisor

ALTERNATE TITLE(S): PA Manager, Authorization & Intake Manager

COMPANY: Freedom Health Systems, Inc. (in support of all customer companies under contract)

DIVISION: Accounting & Finance

DEPARTMENT: Accounts Receivables

UNIT: Prior Authorization

BENEFITS PACKAGE: Ineligible.

WORK SCHEDULE: Monday - Friday, 8:00 AM EST - 5:00 PM EST

ACCOUNTABLE TO: Accounts Receivables Department Manager (Controller in the absence of the Accounts Receivables Department Manager)

ACCOUNTABLE FOR: Managing prior authorization and initial intake processes for medical, behavioral health, and support services across all affiliates

CLASSIFICATION: W8BEN

COMPENSATION RANGE: PHP 482.16 per hour

ANTICIPATED TRAVEL: none

SUMMARY OF POSITION RESPONSIBILITIES:

The Prior Authorization Manager oversees the end-to-end authorization workflow, ensuring that service requests submitted to Medicaid, Medicare, and commercial payers meet the criteria for approval and are processed within required timelines. This role supervises a team of Prior Authorization Associates and collaborates with clinical and billing departments to ensure documentation accuracy, compliance, and reimbursement alignment.

This position is supervised by the Accounts Receivables Department Manager and plays a critical role in supporting clean claims and timely payment. The Prior Authorization Manager is also responsible for ensuring that all clients receiving medical or behavioral health services are fully prior authorized at least three (3) business days prior to the scheduled service date.

The manager ensures that pre-authorization requirements are met for behavioral health, primary care, housing-related supports, and other specialty services. They are also responsible for managing intake triage, authorization submissions, appeals coordination, and payer correspondence.

SCHEDULED DUTIES AND RESPONSIBILITIES:

• Supervise daily operations of the prior authorization and intake team
• Maintain updated knowledge of payer-specific authorization requirements and clinical documentation standards
• Review and approve initial and continuing authorizations for submission
• Collaborate with providers, case managers, and clinical documentation teams to obtain and verify required records
• Ensure all requests are submitted accurately and within deadlines to avoid care delays or denied claims
• Guarantee that all medical and behavioral health clients are authorized no later than three business days prior to service
• Monitor and manage team productivity metrics (e.g., turnaround time, approval rates, rework rate)
• Develop internal workflows and SOPs to standardize intake and authorization processing
• Train and cross-train team members on systems, policy changes, and payer updates
• Coordinate appeal and reconsideration submissions for denied authorizations
• Maintain accurate and auditable logs of authorizations, expiration dates, and renewal status
• Serve as liaison between the billing department and clinical teams to ensure pre-authorization alignment with reimbursement expectations
• Provide weekly reporting to the Director of Operations on authorization volume, turnaround times, and outcomes

UNSCHEDULED DUTIES AND RESPONSIBILITIES:

• Assist your supervisor with any work-related tasks as requested, taking initiative where possible
• Remain informed and compliant with regulations and standards, including COMAR, CARF, and other relevant governing bodies, as well as company policies and procedures
• Support the maintenance of a safe work environment by participating in drills and safety trainings as requested
• Maintain confidentiality of all records, especially those relating to client treatment or financial information
• Participate in external and internal audits/surveys (CARF/CSA/OHCQ) as directed by the supervisor
• Contribute to quality assurance and performance improvement plans by conducting audits and activities that ensure regulatory compliance
• Participate in audit preparation and respond to payer or licensing inquiries as needed
• Support onboarding of new programs by identifying payer authorization requirements
• Collaborate with quality assurance and compliance teams to address trends and implement process improvements
• Assist with coverage or overflow of authorization tasks during high-volume periods
• Attend clinical operations or cross-departmental meetings to stay aligned with service delivery goals

PHYSICAL DEMANDS:

• Prolonged periods sitting at a desk and working on a computer
• Frequent meetings via video or phone; occasional in-person site visits

WORKING CONDITIONS:

• Remote
• Fast-paced, deadline-driven environment with collaborative teams

COMPETENCIES AND SKILLS:

• Strong knowledge of prior authorization procedures across Medicaid, Medicare, and commercial payers
• Attention to detail and document accuracy
• Team supervision and training skills
• Excellent communication and collaboration with clinical and administrative departments
• Strong time management and prioritization abilities
• Proficiency with EHR systems and payer portals

LEVEL OF EDUCATION / TRAINING / QUALIFICATIONS:

• Associate or Bachelor's degree in Health Administration, Nursing, or related field (required)
• Minimum 3 years of experience in prior authorization, with at least 1 year in a supervisory or team lead capacity
• Familiarity with behavioral health and Medicaid service models preferred
• Experience with managed care plans, appeals processes, and payer documentation standards
• Ability to pass background and reference checks