Senior Prior Authorization Specialist (409) (Project Management)

Kings View is a nonprofit leader in providing behavioral health services to the underserved community, is currently seeking a driven Senior Prior Authorization Specialist tojoin our mission to provide compassionate services to those with limited resources. Our ideal candidate will have a passion to promote social justice and societal awareness, respect for human dignity, and lead with integrity while listening and responding to the community in need.

Senior Prior Authorization Specialist (409)
Fresno, CA

Reporting to the Finance Director/Accounting Manager, the Senior Prior Authorization Specialist is responsible for providing oversight and obtaining prior authorizations for mental health services in accordance with payer requirements. This role supports timely access to care and reimbursement for Kings Views fee-for-service programs, including enhanced care management, community services, and private pay/managed care populations. The Senior Specialist works closely with healthcare providers, insurance companies, and patients to collect necessary documentation, submit authorization requests, and follow up on approvals or denials. Serving in a lead capacity, this position also provides onboarding, training, and guidance to new and existing staff while helping to maintain the overall book of business. The Senior Specialist collaborates with billing and program teams to identify and resolve barriers to clean claims and reimbursement and contributes to other revenue cycle functions as needed. A strong understanding of mental health services and payer authorization protocols is essential for success in this role.

How will I contribute
Obtain and manage prior authorizations and referrals for mental health services in strict compliance with insurance payer requirements, ensuring timely approvals that support patient access and maximize service reimbursement.Create, review, evaluate, and accurately track all prior authorization requests and decisions, maintaining comprehensive documentation within the medical records system.Verify patient insurance coverage and eligibility, ensuring requested services align with confirmed benefits.Serve as a key liaison between healthcare providers, patients, and insurance companies to proactively resolve authorization issues and handle escalations efficiently.Research, compile, and submit necessary documentation to appeal denied claims or authorization requests, advocating for optimal patient care and reimbursement.Stay informed of updates in insurance policies, payer coding practices, and regulatory requirements to maintain compliance and enhance authorization procedures.Lead initiatives to optimize revenue, billing, and collections processes within fee-for-service mental health programs by applying industry best practices.Oversee change management related to referral and authorization processes, including updates to payer requirements, portal workflows, and insurance mandates, ensuring effective analysis and clear communication to stakeholders.Collaborate cross-functionally with clinical teams, IT, finance, leadership, and external partners to identify and implement system and process improvements.Review and interpret contract terms and conditions pertaining to revenue cycle deliverables, ensuring adherence to authorization and billing requirements.Support the planning and execution of special projects and work plans to drive operational excellence.Maintain strict compliance with all applicable confidentiality laws, organizational policies, and ethical standards.Communicate promptly and clearly with programs regarding both covered and non-covered services to facilitate appropriate care coordination.Provide onboarding, training, and ongoing mentorship to new and existing staff on prior authorization protocols and billing processes to ensure team competency and consistency.Perform additional duties as assigned to support the overall effectiveness of the revenue cycle and mental health program operations.

What I bring
Highschool Diploma (or Equivalent) 3 years experience in front office operations, insurance eligibility verification, prior authorizations, or billing within medical, behavioral health, or nonprofit healthcare environments. Demonstrated proficiency in insurance eligibility and prior authorization workflows, with a clear understanding of how these impact claims, billing and revenue cycle processes. Skilled in using payer portals, electronic submission platforms, and Electronic Health Records (EHR) to support timely and accurate processing of authorizations and referrals. Understanding of HIPAA and regulatory compliance.Class C Driving LicenseIn depth knowledge of insurance prior authorization and referral management, including understanding payer-specific requirements, documentation standards, and turnaround expectations. Hands-on experience with key platforms such as Availity, Credible, Office Ally and other clearinghouse and payer portal systems. Strong familiarity with payer communication workflows, including electronic transmission, fax-based requests and medical necessity documentation.Moderate level of experience with Excel and proficient with business software tools. Comfortable working with large datasets, identifying discrepancies, and reconciling authorization information with clinical and billing teams. Adept at troubleshooting complex authorization and referral scenarios, with the ability to escalate appropriately and resolve barriers to service within timelines. Strong work ethic and ability to lead and support cross-functional teams in a collaborative One Team culture while maintaining healthy accountability for your respective job duties. High attention to detail, excellent organizational skills, and ability to manage competing priorities effectively. Strong interpersonal and communication skills with a commitment to fostering a positive, solutions-focused environment across departments and programs.Associate degree in health science, healthcare administration, business or related field; Bachelors degree preferred. Certification in Medical Billing and Coding (CPC, CCS, or equivalent) is highly desirable. Previous experience working in nonprofit healthcare or community-based behavioral health organizations. Familiarity with previous experience with referrals and authorizations focused on nonprofit healthcare organizations, certification in Medical Billing and Coding is highly desirable.

The Benefits
Medical, Dental, Vision InsuranceLife and Long-Term Disability Insurance401k planVacation timeTwelve (12) Paid HolidaysEducation Reimbursement Program up to $1000 per yearReferral ProgramEmployee Assistance ProgramAn environment of like-minded people reaching for the same goalServing the underserved communityA sense of purpose

Who We Are
Since 1951, Kings View leads the community in providing behavioral health services to the underserved population. We have a strong tradition of commitment, and we focus on serving rural communities where health resources are often limited. Our people treat the community with care and compassion. We stand by our cornerstone and philosophy of valuing each persons worth, dignity and wholeness in body, mind, and spirit. Our principal core values echo throughout the organization and into our patient-focused programs. At Kings View we are dedicated to continuing our demonstration in the unparalleled commitment to wellness and recovery within each community we serve. Join us and apply today.