Utilization Review & Authorization Coordinator

Utilization Review & Prior Authorization Coordinator Remote | Contract / Part-Time to Full-Time | Behavioral Health | Indiana Medicaid | Expert Level ABOUT THE ORGANIZATION We provide Partial Hospitalization (PHP / ASAM Level 2.5), Intensive Outpatient (IOP), and recovery housing services across a network of twelve residential properties. We contract with four managed care organizations — Anthem, MHS, CareSource, and AMBetter — and operate Kipu EMR with Waystar as our revenue cycle platform. Our team is values-driven, fast-moving, and committed to delivering measurable outcomes for the individuals we serve. THE ROLE We need a sharp, self-directed UR/PA Coordinator who can own the authorization pipeline end-to-end — from initial submission through appeals — across our PHP and IOP service lines. This is not a data-entry role. You will work directly with our clinical and billing teams to ensure every active client has a valid, current authorization, and that no clinically appropriate admission is lost to a process failure. CORE RESPONSIBILITIES • Submit initial prior authorization requests for PHP (ASAM 2.5) and IOP admissions across all four MCO payers in a timely manner • Conduct concurrent review submissions at required intervals; document clinical justification aligned to ASAM criteria and MCO-specific guidelines • Track authorization status in Waystar and our internal Google Sheets authorization log; flag gaps and expiring auths proactively • Coordinate peer-to-peer calls between our Clinical Director and MCO Medical Directors when initial requests are denied • Prepare and submit Level I and Level II appeals with supporting clinical documentation; maintain denial reason tracking • Liaise with Kipu EMR to ensure documentation supports authorization requests (treatment plans, group notes, assessments) • Communicate authorization updates to the clinical team and update Kipu accordingly • Maintain compliance with all HIPAA privacy and security standards in every communication and workflow • Generate weekly UR dashboard reports: auth approval rates, average turnaround time, denial rates by payer, and outstanding appeals REQUIREMENTS Non-Negotiable • Minimum 2 years of UR/PA experience in behavioral health (SUD or mental health) • Demonstrated experience working with Indiana Medicaid MCOs (Anthem, MHS, CareSource, or AMBetter) • Working knowledge of ASAM criteria at Levels 2.5 and 3.1+ • Proven ability to write clinical justification narratives that win authorizations and appeals • Comfortable operating independently in a remote environment with minimal supervision Preferred Qualifications • Experience in Kipu EMR • Waystar / RCM platform familiarity • Availity portal proficiency • CPUR, CPHQ, or similar certification • Background in PHP/IOP clinical operations • Experience with Recovery Works / SOR payer workflows • Strong Google Sheets / Excel skills • Familiarity with ICD-10 and H-code billing WORKING EXPECTATIONS • Availability: Must be reachable during core hours (8AM – 5PM ET, Mon–Fri) for time-sensitive auth requests and peer-to-peer coordination • Turnaround: Initial authorization submissions completed within 24 hours of referral; concurrent reviews submitted no later than 48 hours before current auth expiration • Communication: Weekly status update via our internal platform; escalation of urgent denials within 2 business hours • Tools: Must have reliable internet, HIPAA-compliant workstation, and ability to access web-based portals (Kipu, Waystar, Availity, MCO portals) • BAA: Must be willing to sign a Business Associate Agreement prior to start HOW TO APPLY Submit a proposal that directly addresses the following. Generic cover letters will not be reviewed. 1. Describe your experience submitting prior authorizations for PHP or IOP programs — which payers, what volume, and what your approval rate was. 2. Walk us through how you handle a concurrent review denial from an MCO. What is your process? 3. Have you worked with Kipu or Waystar? If so, describe specifically how you used each platform in a UR context. 4. What does your current availability look like, and how many active clients or accounts can you manage simultaneously?