annaautismcare - Authorization & Eligibility Specialist
Requirements
• Minimum of 1-2 years in insurance verification and prior authorizations. • Working knowledge of health insurance payers. (Commercial, Medicaid, Managed Care) • Experience verifying benefits and submitting authorizations through payer portals • Strong attention to detail with a high level of accuracy in documentation • Effective communication skills, with the ability to collaborate across clinical and operations teams • Experience with behavioral health and/or, Applied Behavior Analysis (ABA) Therapy. • Familiarity with managed care organizations (MCOs) and state-specific Medicaid plans (e.g., MassHealth or similar) • Prior experience working in a multi-site or high-growth healthcare organization • Knowledge of medical necessity criteria and payer-specific authorization guidelines
Benefits
• Verify client insurance eligibility and active coverage prior to start of services • Review and document benefit details including copays, deductibles, coinsurance, visit limits, and exclusions • Confirm in-network/out-of-network status • Identify services requiring prior authorization based on payer guidelines and benefit plans • Communicate benefit coverage and potential financial responsibility with families • Maintain accurate and up-to-date documentation of eligibility verification in the practice management system • Monitor eligibility monthly and flag coverage lapses, plan changes, and retro activation that may delay care or impact reimbursement • Authorizations: • Submit initial and ongoing prior authorization requests to insurance payers • Ensure all required clinical documentation is complete and aligned with payer requirements • Track authorization status and follow up with payers to prevent delays in service start or continuation • Manage authorization approvals, denials, and modifications (including units, dates, and service codes) • Coordinate with clinical teams to align authorized services with treatment plans • Maintain detailed records of authorization activity, including reference numbers and approval details
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