ABA Authorization Specialist

About the role

Behavioral Health Works is an expanding company dedicated to responsible and sustainable growth. We are committed to delivering personalized ABA therapy for children and adolescents diagnosed with Autism Spectrum Disorder (ASD). ABA therapy helps individuals with Autism improve socially significant behavior, following the principles of Behavior Analysis. Our extensively trained BCBAs, Case Supervisors, and Technicians collaborate closely with parents to create tailored treatment plans that address the distinct requirements of each child.

Responsibilities

• Submit, track, and manage initial, concurrent, and reauthorization requests for ABA therapy services.
• Monitor authorization status and proactively follow up with insurance providers to ensure timely approvals and prevent interruptions in care.
• Track authorization utilization and expiration dates, ensuring renewal requests are submitted within required timeframes.
• Communicate authorization approvals, denials, modifications, and requests for additional information to internal stakeholders.
• Collaborate with BCBAs and clinical teams to obtain treatment plans, assessments, progress reports, and supporting documentation required for authorization submissions.
• Verify payer authorization requirements and maintain knowledge of commercial insurance, Medicaid, and managed care guidelines.
• Absorb authorization-related issues, denials, and appeals.
• Maintain accurate authorization records and documentation within CentralReach and other company systems.
• Ensure compliance with payer requirements, HIPAA regulations, and company policies.
• Support authorization reporting, audits, workflow improvements, and other administrative functions as needed.

Qualifications

• Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Psychology, or a related field preferred.
• Minimum of 2 years of experience in healthcare authorizations, insurance verification, utilization management, or a related healthcare administrative role.
• Experience with ABA therapy authorizations strongly preferred.
• Knowledge of insurance authorization processes, commercial payers, Medicaid, and managed care plans.
• Proficiency with CentralReach, including the Authorizations Module.
• Strong working knowledge of Google Workspace, including Google Sheets, Docs, Gmail, and Drive.
• Exceptional organizational skills and attention to detail.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.

Preferred Qualifications

• Experience in behavioral health, ABA, or pediatric healthcare.
• Familiarity with authorization appeals and denial management.
• Experience working with multiple insurance payers across various states.