This is a fully remote position, open to applicants in New York.

📋 Description

• Collaborate with the Prior Authorizations vendor to address intricate authorization challenges.

• Coordinate efforts with providers, patients, and payors.

• Act as the in-house authority on prior authorizations and pre-certification requests and requirements for a specific region or group of payors.

• Assist the team in procuring documentation, resolving authorization denials, and navigating payer stipulations.

• Partner with the operations team to pinpoint bottlenecks, inefficiencies, and opportunities within the intake process.

• Create processes and training resources for offshore team members managing daily prior authorization matters.

• Take ownership of Prior Authorization outcomes and KPIs for the designated region or payors.

⛳️ Requirements

• Over 5 years of experience in ABA intake, specifically focusing on Prior Authorizations or Insurance Certification.

• Comprehensive understanding of the ABA pre-certification process for Tricare East, Medicaid MCOs, BCBS State plans, Aetna, and/or Cigna.

• Highly organized with a strong commitment to follow-through.

• Exceptional attention to detail and the ability to interpret complex clinical documents, payer feedback, and EHR data related to prior authorization workflows.

• Proficient and confident communication skills with parents, clinicians, and payer representatives.

• Strong problem-solving capabilities.

• Comfortable with ambiguity and making real-time judgments.

• Must be a US Citizen, Green Card Holder, or eligible for a TN Visa; the application will inquire about current or future visa sponsorship requirements.

• Phone number and resume are required for application submission.