Benefits and Authorization Specialist

Company Description

Therapy & Beyond is one of the largest BCBA-owned ABA organizations, founded and led by Dr. Regina Crone, BCBA-D, since 2006. At Therapy & Beyond we approach the needs of each patient both individually and as part of a dynamic interdisciplinary team working with experts in applied behavior analysis (ABA) therapy, speech-language pathology, occupational therapy, and counseling. We love helping individuals reach their full potential by supporting not only the patient but also their family. We are passionate about what we do while remaining true to our defining core values of: Putting People First, Doing Our Best Together, Making Therapy Fun, and Above All, We grow potential

Job Description

The Authorization and Benefits Specialist is responsible for the full lifecycle of insurance verification and authorization. This role ensures financial reimbursement by securing pre-authorizations, obtaining retroactive approvals, and maintaining active authorizations for ongoing care. The Specialist serves as a liaison between the organization, third-party payors, and clinical staff to prioritize efficiency.

JOB-SPECIFIC FUNCTIONS:

• Authorization Management: Initiate and secure initial benefits, pre-authorizations, and re-authorizations via payor portals, fax, or telephone.
• Follow-Up & Tracking: Strictly adhere to follow-up schedules (e.g., 3, 7, 14, 30 days) based on payor guidelines to expedite claims and prevent revenue loss.
• Complex Case Resolution: Manage high-complexity requests, including retroactive authorizations and Single Case Agreements (SCAs) for out-of-network patients.
• Data Integrity: Verify that authorization quantities, CPT codes, and effective dates are accurately entered into the practice management system.
• Clinical Collaboration: Coordinate directly with healthcare providers to secure necessary clinical notes, letters of medical necessity, and supporting documentation in a timely manner.
• Process Improvement: Develop and maintain a centralized "Payor Master List" and internal authorization manuals to standardize workflows and improve efficiency.
• Compliance: Review and interpret insurance group pre-certification requirements to ensure full compliance before services are rendered.
  
  

Qualifications

• Education: Associate’s of Bachelor's degree preferred in Healthcare Administration or related field preferred.
• Experience: Minimum of 2 years of experience in insurance verification, medical billing, or authorization management.
• Technical Skills: Proficiency with electronic medical records (EMR) systems, and payor portals.
• Soft Skills: Strong written and verbal communication skills with the ability to build rapport with insurance representatives. Excellent organizational skills and attention to detail.
  
  

Additional Information

• Generous benefit Package:
• Medical, Dental, Vision, and Disability
• Company Paid- Life Insurance
• 401K with company match
• Company Paid Short-Term Disability
• HSA and FSA options
• Employee Assistance Program
• Employee Recognition