Benefits and Authorization Specialist
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Job Location:
Flower Mound, TX - USA
Monthly Salary:
Not Disclosed
Posted on:
19 hours ago
Vacancies:
1 Vacancy
Department:
Job Summary
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: Associates of Bachelors 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
Remote Work :
No
Employment Type :
Full-time
Key Skills
- Customer Service
- Fmla
- HIPAA
- Microsoft Outlook
- Benefits Administration
- HRIS
- Payroll
- Employment & Labor Law
- ADP
- Human Resources
- Phone Etiquette
- Workday
About Company
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 beh ... View more
