Position Overview
The Insurance Verification/Authorization Specialist bridges daily administrative workflows and clinical authorization tracking for our ABA therapy practice. This role is essential in securing reimbursement and maintaining continuous client care by verifying benefits, and directly partnering with Board Certified Behavior Analysts (BCBAs) to ensure treatment authorizations are submitted, tracked, approved, and renewed without disruption.
Key Responsibilities
Payor Verification & Revenue Cycle Support
Benefit & Eligibility Verification: Contact insurance payors directly to verify active client behavioral health benefits, out-of-pocket costs (copays, coinsurance, deductibles), and service-specific pre-authorization criteria.
Service Authorization: Obtain initial authorization for ABA services for new clients from insurance companies.
Denials & Appeals: Investigate denial reasons, gather supporting clinical and administrative documentation, submit appeals, and reprocess corrected claims to ensure timely reimbursement.
BCBA & Clinical Authorization Coordination
Deadline & Unit Tracking: Maintain real-time tracking for initial authorizations, concurrent reviews, and re-authorizations; proactively notify BCBAs ahead of expiring authorized units and upcoming clinical report deadlines.
Quality & Pre-Submission Audits: Audit clinical treatment plans and authorization requests to ensure client demographics, service dates, CPT/HCPCS codes, and requested hours match BCBA clinical recommendations prior to submission.
Submission Management: Securely transmit BCBA clinical reports, treatment plans, assessments, and supporting medical records through payor portals, or secure channels for authorization review.
Approvals & Status Dissemination: Monitor payor portals for approvals, extract approved authorization details (approved units, service dates, authorized codes), log them into company systems, and promptly disseminate status updates to BCBAs, scheduling, and billing teams.
Clinical Appeal & Peer-to-Peer Support: Partner with BCBAs to assemble documentation, schedule peer-to-peer physician reviews, and submit secondary appeals for denied or reduced authorization requests for therapy hours.
General Operations & Data Maintenance
Maintain clean, organized electronic records, authorization logs, and client profile demographic data in company practice management systems.
Keep updated contact lists, payor portal credentials, and billing/authorization reference guides.
Provide general administrative support to the Team on special projects as assigned.
Qualifications
Education and experience: High School diploma minimum; Associate or Bachelor’s degree in Healthcare Administration, Business, or Psychology/Behavioral Health preferred.
Healthcare Experience: Minimum of 2–3 years of dedicated prior authorization, insurance verification, or front-end revenue cycle experience in an outpatient healthcare environment (prior experience in an ABA (Applied Behavior Analysis), behavioral health, or therapy clinic setting is strongly preferred).
ABA/Behavioral Health Experience: 1+ years of direct experience handling authorizations and concurrent reviews specifically within an Applied Behavior Analysis (ABA) with prior knowledge of Centra Reach strongly preferred.
Regulatory Compliance: Strict adherence to HIPAA guidelines, medical documentation confidentiality, and timely filing rules.
Insurance Knowledge: Working knowledge of prior authorization and appeals process (commercial payors and web portal – ie: United, Florida Blue, Aetna, Cigna, Oscar, etc. )
Technical Skills: Proficiency in electronic practice management / billing software (e.g., Central Reach is helpful) and Google Workspace (especially high proficiency in Google Sheets), Mac environment.
Attention to Detail: High accuracy in working with numbers, calculating billable hours, auditing dates, authorization numbers, CPT codes, and clinical hours requested.
Communication: Clear, professional written and phone communication skills for interacting with insurance reps and clinical staff.
Compensation details: 21-23 Hourly Wage
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