Job Description

We are seeking a Authorizations Specialist to oversee the authorization and re-authorization of services for incoming clients. This critical role ensures that clients receive timely approvals for ABA therapy by managing the entire authorization process with insurance providers and funding sources. The ideal candidate has experience in healthcare utilization review, strong knowledge of ABA services, and the ability to navigate insurance requirements efficiently.

Key Responsibilities:

• Authorization Management:
  • Submit and track initial and ongoing authorization requests for ABA services.
  • Review documentation to ensure compliance with insurance payer requirements.
  • Proactively follow up on pending authorizations and address any denials or requests for additional information.
• Insurance Coordination:
  • Communicate directly with insurance representatives to verify coverage and resolve issues.
  • Maintain up-to-date knowledge of insurance policies, authorization criteria, and industry standards.
  • Collaborate with billing and administrative teams to ensure accurate service approvals.
• Clinical Documentation Review:
  • Work closely with clinical teams to ensure treatment plans and assessment reports align with insurance guidelines.
  • Assist in gathering and organizing necessary clinical documentation for submission.
• Tracking & Compliance:
  • Maintain detailed records of authorization requests, approvals, and expiration dates.
  • Provide regular updates to internal teams regarding authorization statuses and renewal deadlines.
  • Ensure all authorizations align with ethical and regulatory standards in the ABA field.

Qualifications:

• Experience in utilization review, prior authorizations, or insurance coordination (ABA experience preferred).
• Strong understanding of insurance processes, including Medicaid and commercial plans.
• Exceptional organizational and problem-solving skills.
• Ability to manage multiple tasks and meet strict deadlines.
• Excellent communication and customer service skills.
• Proficiency in electronic health record (EHR) systems and Microsoft Office.

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