Work with our Prior Authorizations vendor to resolve complex authorization issues including coordinating with our providers, patients and payors

Be the inhouse expert for all prior authorizations and pre-certification requests and requirements for a region or set of payors

Support the team in chasing down documentation, resolving auth rejections, and navigating payer requirements

Work with the operations team to identify bottlenecks, inefficiencies, and opportunities across the intake workflow

Develop processes and training materials for offshore team members to resolve day-to-day prior authorization issues

Own Prior Authorization outcomes and KPIs for your region / payors

[REQUIRED] 5+ years of experience in ABA intake with a specific focus on Prior Authorizations or Insurance Certification

[REQUIRED] Strong understanding of the ABA pre-certification process for Tricare East, Medicaid MCOs, BCBS State plans, Aetna, and/or Cigna

You are highly organized and relentless about follow-through, nothing falls through the cracks on your watch

Extreme detail orientation and ability to read complex clinical documents, payor feedback, and EHR data with regards to prior authorization workflows

You communicate clearly and confidently with everyone from parents to clinicians to payor contacts

You are a problem-solver - you identify the issue and fix it

Prior Authorization Manager

Responsibilities