Authorization Specialist

At Therapy & Beyond, we are passionate about empowering families and guiding our clients toward success! As an Authorization Specialist, you will play a vital role in our mission by managing the full lifecycle of insurance verification and authorization. In this key role, you’ll help ensure seamless financial reimbursement by securing pre-authorizations, obtaining retroactive approvals, and maintaining active authorizations for ongoing care. Serving as a trusted liaison between our organization, third-party payors, and dedicated clinical team, you will help minimize denials so our staff can focus on what matters most: delivering exceptional care.

JOB-SPECIFIC FUNCTIONS

• Team Mentoring & Oversight: Provide guidance and support to team members on authorization processes, best practices, and payor requirements.
• 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.
• Education: Associate’s of Bachelor's 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.
• 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