Prior Authorization Specialist

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

📋 Description

• Take charge of the authorization process for intricate cases, demonstrating expertise in TRICARE, including ECHO enrollment and prior authorization workflows.

• Oversee escalations from the prior authorizations vendor, Silna.

• Assist with documentation follow-up, resolution of authorization rejections, and navigation through payer requirements.

• Collaborate with billing and insurance operations to address issues.

• Ensure timely and effective communication among families, BCBAs, referring physicians, and internal teams.

• Set clear expectations with families regarding timelines, documentation needs, and subsequent steps.

• Manage high-stakes or escalated family situations.

• Identify bottlenecks and inefficiencies within the intake workflow in collaboration with operations.

• Drive process improvements from identification through to implementation.

• Maintain precise tracking and reporting across various systems.

⛳️ Requirements

• A minimum of 5 years of experience in ABA intake.

• A specific focus on prior authorizations is highly preferred.

• Direct experience with TRICARE authorizations, including ECHO enrollment and prior authorization workflows.

• Highly organized with strong follow-through skills.

• Clear and confident communication abilities with families, clinical staff, and referring physicians.

• Strong problem-solving skills.

• Capability to make sound judgment calls in real-time amidst ambiguity.

• Approachable and supportive while upholding high standards.

🏝️ Benefits

• Opportunity to significantly influence the speed at which families access care.

• Operational excellence has a direct impact on patient outcomes.

• Involvement in a critical function at an early-stage, rapidly growing company.

• Join a team of high-performing professionals in the ABA sector.