Authorization and Insurance Specialist

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

The Financial Clearance Authorization and Insurance Specialist position 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 directly correlates to mitigating and reducing bad debt for Centria Autism by initiating the continuous review and follow-up of the eligibility and pre-authorization for Diagnostic Evaluations, Initial Assessments, and Ongoing Treatment (if applicable by payor/market). The Authorization and Insurance Team should identify and understand all payor rules for the proper adjudication of the pre-auths and verification of ABA Therapy insurance coverage and benefits for our client families when needed. They are responsible for managing the overall pre-auth process, which includes but is not limited to following up with the Operations/Clinical Teams and coordinating all applicable documentation and action needed to complete the securing of an approved authorization.

The Authorization and Insurance Team provides superior customer service and support to the Operations Teams and all other Revenue Cycle Management/Centria Autism teams that provide services and support to our client families. And most importantly always conduct themselves in a manner that supports our mission.

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.