Authorization and Insurance Specialist

This is a remote role.

About the Role

The Authorization and Insurance Specialist is responsible for collecting client demographic and insurance information, processing that information for collections and reimbursement, and the timely and successful submission of pre-authorizations (pre-auths) of services to insurance payors. This role directly mitigates and reduces bad debt for Centria Autism by initiating continuous review and follow-up of eligibility and pre-authorization for Diagnostic Evaluations, Initial Assessments, and Ongoing Treatment (if applicable by payor/market). The Authorization and Insurance Team identifies and understands all payor rules for proper adjudication of pre-auths and verification of ABA Therapy insurance coverage and benefits for client families. They manage the overall pre-auth process, including coordinating documentation and actions needed to secure approved authorizations, while providing superior customer service to Operations Teams and other Revenue Cycle Management/Centria Autism teams.

Responsibilities

• Work collaboratively with the Intake Team to verify insurance coverage and benefit details for ABA Therapy.
• Confirm authorization requirements per payor for all incoming leads.
• Request and track commercial and Medicaid authorizations.
• Maintain active insurance coverage(s) for all clients.
• Communicate effectively, both oral and written, with internal staff, clients/guardians, and payors/insurance companies.
• Ensure strict confidentiality of client records according to policy and procedures; adhere to HIPAA regulations.
• Make administrative and procedural decisions and judgments on confidential issues.
• Demonstrate knowledge of computer data entry systems, protocols, and procedures.
• Answer and direct phone calls to appropriate parties and handle time-sensitive issues from internal staff.

Requirements

• High School diploma or equivalent (minimum requirement).
• 1—2 years of call center or customer service experience.
• Minimum typing proficiency of 55 words per minute with errorless typing.
• Knowledge of in-state and out-of-state commercial insurance plans (preferred).
• Working knowledge of ABA Therapy regarding frequency and Current Procedural Terminology (CPT) codes (preferred).
• Knowledge of Michigan Medicaid (preferred).
• Basic computer skills and working knowledge of laptop/desktop PC.
• Proficiency in Microsoft Suite and G Suite.
• Ability to follow written instructions and use computers/software programs.

Skills

• Proficient in Microsoft Office Suite, especially spreadsheet programs.
• Superb customer service and phone etiquette skills.
• Highly organized with strong analytical and personnel management skills.
• Ability to apply and adopt practices and techniques to specifications set by senior leadership.
• Effective communication skills, both written and verbal, with internal and external stakeholders.
• Ability to build rapport, explain complicated information clearly, handle challenging phone conversations, and represent the Centria brand.
• Ability to organize, prioritize, and handle multiple tasks while adhering to deadlines.
• Results-driven with critical thinking and problem-solving skills.
• Proven adaptability with a willingness to work collaboratively and individually.
• Excellent interpersonal, customer relationship, and listening skills.
• Strong work ethic with attention to detail, accuracy, and quality.
• Established track record of generating error-free work.

Pay

$17.00 - $20.00 per hour plus bonus.

Schedule

Centria's office hours are Monday through Friday from 8:30 AM – 6:00 PM. Additional time or occasional shifts may be required to meet company objectives.

Working Conditions

• This role will require sitting most of the day, as well as periodic walking and standing.
• Physical requirements may include bending, reaching, lifting, pushing, or pulling up to 30 pounds.
• Close visual acuity on computer screens or monitors, with the ability to analyze data and figures.